VADM WillartJ P. Arentzen, MC, USN
Surgeon General of the Navy
RADM R.G.W. Williams, Jr., MC, USN
Deputy Surgeon General
Director of Public Affairs
ENS Richard A. Schmidt, USNR
Virginia M. Novinski
Nancy R. Keesee
Contributing Editor-in-Chief: CDR C.T.
Cloutier (MC); Aerospace Medicine:
CAPT M.G. Webb (MC); Dental Corps:
CAPT R.D. Ulrey (DC); Education:
CAPT S.J. Kreider (MC); Fleet Sup-
port: LCDR J.D. Schweitzer (MSC);
Gastroenterology: CAPT D.O. Castell
(MC); Hospital Corps: HMCM H.A.
Olszak; Legal: LCDR R.E. Broach
(JAGC); Marine Corps: CAPT D.R.
Hauler (MC); Medical Service Corps:
CAPT P.D. Nelson (MSC); Naval Re-
serve: CAPT J.N. Rizzi (MC, USN);
Nephrology: CDR J.D. Wallin (MC);
Nurse Corps: CAPT P.J. Elsass (NC);
Occupational Medicine: CDR J.J. Bel-
lanca (MC); Preventive Medicine:
CAPT D.F. Hoeffler (MC); Psychiatry:
CAPT S.J. Kreider (MC); Research:
CAPT J. P. Bloom (MC); Submarine
Medicine: CAPT J.C. Rivera (MC)
POLICY: U.S. Navy Medicine is is official publication
of the Navy Medical Department, published by the Bureau
of Medicine and Surgery. It disseminates to Navy Medical
Department personnel official and professional information
relative to medicine, dentistry, and the allied health sci-
ences. Opinions expressed are those of the authors and do
not necessarily represent the official position of the Depart-
ment of the Navy, the Bureau of Medicine and Surgery, or
any other governmental department or agency. Trade
names are used for identification only and do not represent
an endorsement by the Department of the Navy or the Bu-
reau of Medicine and Surgery. Although U.S. Navy Medi-
cine may cite or extract from directives, official authority for
action should be obtained from the cited reference.
DISTRIBUTION: U.S. Navy Medicine is distributed to
active-duty Medical Department personnel via the Standard
Navy Distribution List. The following distribution is author-
ized: one copy for each Medical, Dental, Medical Service
and Nurse Corps officer: one copy for every 10 enlisted
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crease the number of allotted copies should be forwarded to
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CORRESPONDENCE: All correspondence should be
addressed to: Editor, US. Navy Medicine. Department of
the Navy. Bureau of Medicine and Surgery (Code 0010),
Washington, D.C. 20372. Telephone: (Area Code 202) 254-
4253, 254-4316, 254-4214; Autovoo 294-4253, 294-4316. 294-
4214. Contributions from the field are welcome and will be
published as space permits, subject to editing and possible
The issuance Df this publication is approved in accordance
with Department of the Navy Publications and Printing
Regulations (NAVEXOS P-35).
Vol. 69, No. 9
1 From the Surgeon General
2 Department Rounds
At NNMC Bethesda, Group Therapy Puts a Focus on the Family
6 Notes and Announcements
8 Scholars' Scuttlebutt
The Medical School Liaison Officer
10 Instructions and Directives
Naval Aviation Physiology
LCDR T.J. O'Leary, MSC, USN
18 Hospital Corps Career Decision: The Time Is Now!
19 Roster— 1 August 1978
Staff Medical and Dental Officers at Major Activities
23 NAVMED Newsmakers
Bezoar: An Unusual Complication of Surgery for Dumping Syndrome
LCDR G.S. Weinstein, MC, USNR
27 Treatment of Chronic Bacterial Prostatitis with Trimethoprim-Sul-
LCDR D.F. Lynch, Jr., MC, USN
29 BUMED SITREP
COVER: Disabling illness, such as "stroke," is a "personal crisis for the
patient — and a crisis for the whole family," says Ms. Lala Johnson,
Chief of Social Work Service, NNMC Bethesda. In cooperation with
NNMC's Neurological Service, she has begun a unique group therapy
program for "caretakers" of disabled patients (see page 2). Photo re-
printed by permission of the American Heart Association.
From the Surqeon General
'I Am a Patient'
The following — written by CDR
Joseph Smyth (MC) — was sent to
me from Yokosuka. It so impressed
me that I wish to insert it instead of
my own letter to you this month.
You've seen me a hundred times —
with many faces, many forms, many
reasons for being in your care.
I am the frightened, middle-aged
sailor, waiting at your admitting desk,
nervously opening and closing my
I am the shuffling, stoop-shouldered
figure in faded blue pajamas you en-
counter at every corner as you go about
your daily work.
Everything is new and strange to me.
Yesterday I was in familiar surround-
ings and happy, planning my tomor-
rows. Today 1 am in an alien world, try-
ing hard to adjust. The little familiar
things of my own world seem to take on
great importance. 1 may complain to
you. I may rebel against the strange-
ness. You see, I don't want to be in the
hospital; I want to go back to my ship.
From the moment I walk up to your
admitting desk, I am a mass of fears; I
am fearful of the unknown. 1 am
alarmed over the prospect of pain, dis-
figurement — even death. I fear financial
distress or catastrophe. More than any-
thing else, I am lonely.
If 1 tell you my coffee is cold, it may
be because coffee is more than a break-
fast drink to me. . . . Through years of
experience I have come to associate it
with congeniality, friendship, the
warmth and security of shipmates.
. . . [C]old coffee reminds me that I am
among strangers, antiseptic and some-
how frightening strangers.
When I object to early morning awak-
ing, I often mean that I am insecure.
When I report that my nurse or doctor is
indifferent, I often mean I feel forsaken.
Please understand that often, in my
complaints about little things, I am try-
ing to tell you of far deeper needs. Will 1
lose my identity? Will I be exposed to all
. . . sorts of indignities?
I'm afraid that I'll be treated, not as a
sailor, but as a "fascinating gall blad-
der," an "interesting thyroid." I ap-
pear normal, but I have left normalcy
outside your door. Though I am mature,
I have suddenly become a child,
frightened of the long, dark nights.
And, oh, how I want you to be warm and
friendly! . . .
You may tell me that . . . some ' 'dis-
comforts," some "fears" are part of
any hospital stay. I will tell you that I
understand this perfectly when I am not
a patient, but from the minute I enter
your hospital, my outlook changes.
Minor things take on abnormal impor-
Much of my fright . . . comes from
lack of understanding on my part. All
too often you take for granted that I
know these things, and I'm left to grope
for my answers alone. , . .
Help me bridge my initial feelings of
embarrassment. Assure me that the
bedpan is only temporary and that as I
improve I'll be able to look after myself
to a greater degree. Assure me that I
am never alone or abandoned, even on
the busiest hospital day. Reassure me
that my struggle is not a private one —
that my feelings, frustrations, resent-
ments, and emotions are simply a part
of being a patient.
Never forget, you've been a symbol to
people like me ever since the Samari-
tan traveled the road between Jerusa-
lem and Jericho two thousand years
ago. The equipment and the methods
have changed. But the concept con-
You're the benevolent healer. You
cannot — you dare not — change!
Vice Admiral, Medical Corps
United States Navy
Volume 69, September 1978
At NNMC Bethesda, group therapy for 'caretakers'
of disabled patients puts a . . .
Focus on the Family
"You do everything to help the
patients. Why don't you do some-
thing to help the families? "
For Ms. Lala Johnson, who heads
the Social Work Service at the Na-
tional Naval Medical Center, Be-
thesda, Md., this anguished out-
burst hit home with special force.
She herself, like the woman who
confronted her, had had a close
family member disabled by crip-
"That's an excellent idea," she
responded. "Can you identify
enough families with similar prob-
lems so that we could start a
Thus, two years ago, she
launched a unique program of
group therapy for family members
who are "caretakers" of patients
with chronic, disabling disorders.
The Bethesda group is the first of
its kind to be formed at a Navy
medical facility — and perhaps the
first anywhere. Most of its current
members are spouses of patients
who have been discharged from the
NNMC Neurology Service and are
disabled, to varying degrees, by
such disorders as stroke, dementia,
and multiple sclerosis.
The range of disabilities with
which these patients and their fam-
ilies must cope includes hemiplegia,
hemiparesis, aphasia, loss of blad-
der and bowel control, and loss of
mental function. For most of the
patients, regression is inevitable.
In the hospital, trained personnel and special facilities are available
U.S. Navy Medicine
One member summed up the
purposes of NNMC's family group
"to maintain our mental health;
' 'to share our experiences so as to
' 'to try to obtain some interest in
the way of facilities or help for those
The group, small enough so that
members can draw their chairs into
an informal circle, meets weekly at
NNMC for about an hour and a half.
Ms. Johnson — a slight, soft-spo-
ken woman with a warming smile —
provides unobtrusive leadership:
suggesting here, softly probing
there, nudging the talk along when
expression of feelings becomes dif-
ficult, and gently but firmly insist-
ing on confrontation of painful is-
sues. LCDR E. Wayne Massey,
MC, USNR — a young neurologist
who, like Johnson, has had experi-
ence with stroke in his own family —
serves as co-leader and as a re-
source on medical queries.
Above all, the group furnishes a
supportive atmosphere in which
members can express, and begin to
deal with, the devastating emotions
generated in them by a world that
illness has turned upside down.
There's a profound sense of shar-
ing here — not only of feelings, but
of constructive, practical ideas
traded among people who deal with
similar problems. No visitor to the
group can fail to be impressed by its
members' sharp humor, gallantry,
vitality, and real strength.
A primary emotion ventilated in
the group is grief.
One husband of a woman with a
progressive neurological disorder
expressed his continuing sense of
mourning and loss as — from week
to week, from month to month — his
wife loses more of her ability to
function. "It has just become too
much to bear," he said, "too much
Others speak of their loneli-
ness — of the deprivation of com-
panionship from formerly close
spouses whose mental function is
now impaired: "The hardest thing
but after discharge, care will take place at home.
is that there's no one to talk to" . . .
"She's there, but she's not there."
What these families are mourn-
ing, Johnson points out, is really a
kind of death — a death of part of the
patient's body — and the disruption
of close relationships that inevitably
results. Indeed, she says, family
members seem to go through stages
similar to those described by
Kiibler-Ross in her now classic book
On Death and Dying — with one ex-
ception. While the stages of denial,
anger, and depression are fre-
quently seen, the final stage eludes
"I thought the members would
work through their feelings, reach
the stage of acceptance, and leave
the group," Johnson says, "but so
far that just hasn't happened. 1
don't think they ever really reach
"No one who hasn't been through
this experience can ever really un-
derstand what it's like," says one
group member — a sentiment
echoed by all. For the caretaker in
these situations is on duty 24 hours
a day: cleaning house; providing the
patient's meals on time; feeding,
bathing, clothing, and grooming
those who can't perform these
functions unassisted (or at all);
cleaning up after the incontinent;
helping the ambulatory patient get
around; in the case of some pa-
tients, simply being there, in every
spare moment, hoping for some
glimmer of recognition or response.
What most of us think of as
simple matters — dressing, and such
grooming tasks as clipping finger-
nails and toenails — may take the
caretaker hours to accomplish for a
patient who is unable to cooperate.
If the patient is incontinent and un-
able to communicate, the caretaker
tries desperately to anticipate
needs, and thus avert accidents. In
Volume 69, September 1978
some cases, patients may be ambu-
latory but incontinent; thus, every
outing must be carefully planned to
keep the patient always within close
range of a toilet. In cases of de-
mentia, the caretaker may fear
leaving the house long enough to go
to the corner store: a patient who
smokes, left alone, could burn the
Of his two years with the group,
Dr. Massey says: "One thing I've
realized more and more is how re-
strictive this situation is for the pa-
tient's spouse." All too frequently,
relatives or friends who could help,
by staying with the patient long
enough to give the caretaker a brief
respite, withdraw from the scene,
murmuring excuses; "I just can't
stand to see him (her) that way ..."
In a very real sense, Ms. Johnson
points out, the caretaker is a cap-
tive. He or she, no matter how lov-
ing, is caught in a no-exit bind that
elicits frustration, anger, and a de-
sire to escape — emotions closely
followed by overwhelming guilt.
"Is it normal to have these feel-
one caretaker asked. An
important function of the group is to
assure members that these feelings
are indeed most "normal," as are
some even more difficult to express.
When, as in some cases, a family
member can anticipate perhaps 20
or 30 more years of trying to cope,
in an agonizing and ever-worsening
situation, it's small wonder that the
only way out may seem to be his or
her own death — or that of the
patient. And it's also small wonder
that it was more than a year before
group members could bring them-
selves to talk of these inevitable
feelings about suicide and homi-
cide — feelings that, of course, have
nothing to do with intention to act.
Indeed, says Johnson, "One of
the greatest fears the caretakers
express is that they may die before
the patient does. Then who will take
care of him?"
If what has been said so far Recovery is a team effort for therapists, patient, and family.
U.S. Navy Medicine
sounds dismal, the basic tone of the
group is far from that. The constant
focus is on coping — or, as Johnson
puts it, on "helping the family con-
trol the disability, rather than
letting the disability control the
For the caretaker, one of the most
useful of all coping mechanisms is a
brief "escape" from home. Indeed,
his or her own health may require it.
But finding someone else to take
temporary charge of the patient's
care isn't easy. And even when
suitable arrangements can be
made, the caretakers seem to find it
almost impossible to leave their pa-
tients, even for a few hours. (Said
one husband, "I feel as though I'm
Nonetheless, Johnson and Mas-
sey continually stress the need for
family members to get away from
time to time — for part of a day, a
weekend, a week, or whatever they
can work out. And members of the
group who have made their own
first "escapes" offer strong en-
couragement to the others to do
Humor and fantasy are also
important mechanisms in coping, as
a recent group session illustrated.
One woman reported that a travel
brochure she had recently run
across had prompted a week of
happy fantasizing. In her scenario,
Dr. Massey called her husband back
into the hospital for study, just long
enough so that she could go on a
To general laughter, another
member suggested that the fantasy
would have been perfect had she
also dreamed up a doctor's order
not to visit her husband during his
hospital stay — thus averting any
possible feelings of guilt.
While the members of the group
support each other by sharing prob-
lems and working together to find
ways to solve them, they also draw
strength from broader community
Having themselves found the
support of the group invaluable,
they hope their experience will
spark other efforts to help families
in similar plights. To this end, they
have generously invited visitors
from various "helping" agencies to
sit in on sessions, ask questions,
and learn firsthand something of
the problems families with disabled
Both Johnson and Massey are es-
pecially interested in seeing the
group idea take root at other facili-
ties besides NNMC. Social workers
in the Navy are scarce indeed,
Johnson acknowledges. However,
she points out, professionals in
other disciplines with experience in
group dynamics — psychiatrists and
chaplains, for example — could lead
this type of group just as well.
"You need the skills in group
techniques," she says, "but more
important than anything else is the
One great problem for doctors in
dealing with the disabled, says
Massey, is that "they are operating
in a vacuum — they don't see the
patient in the family context." Yet,
he points out, stroke patients at
NNMC, for example, stay in the
hospital for six weeks at most, and
usually go home after two or three.
On NNMC's Neurology Service,
the social worker is involved with
the family from the beginning of a
new patient's hospital stay. (Ideal-
ly, the first contact with referred
families is made within 24 hours
after the patient's admission.) Ms.
Johnson's hope is to bring family
members into the group right away,
so they'll be better prepared for
what they'll have to face when the
patient goes home.
One area frequently overlooked
by the doctor dealing with disabled
patients, says Massey, is sex. He
himself used to be guilty of this, he
says, and he attributes his new
sensitivity on the subject to what he
has learned in the group: "Two
years ago, when patients came back
to the clinic, I didn't ask questions
about sexual function. Now I try to
ask everyone, and patients will say
with relief, 'Well, now that you
ask . . .'"
In some cases, problems with
impotence can be relieved — for
example, one patient is now happily
functioning after implant of a penile
prosthesis. Couples who have diffi-
culty in achieving intercourse be-
cause of the partial paralysis of one
partner may be helped by counsel-
ing on new positions.
But whether or not a sexual prob-
lem is susceptible to solution,
spouses in such situations need
sympathetic understanding in what
can be agonizing personal dilem-
The problems this article has dis-
cussed by no means exhaust the
catalog of difficulties that beset
families of the disabled. Financial
worries, for example, about patients
who will sooner or later require
nursing-home care have not even
been touched on.
Recently, a member of the group
expressed his anger toward a
physician who had examined his
wife and seemed indifferent to signs
of regression she was exhibiting.
"Well, this is the kind of thing
you've got to expect," the doctor
told him. "She's not going to get
any better; she's going to get
"I didn't need anyone to tell me
she's not going to get better — I
knew that," the husband com-
Dr. Massey pointed out that the
physician's disappointing response
could well have resulted from a feel-
ing of helplessness because there
was nothing he could do.
"i can have sympathy for that,"
said Massey. "It's been two years
since I came into the group, and my
reaction to this type of situation has
"The group has been teaching
me, and I'm still learning."
Volume 69, September 1978
Notes & Announcements
Dental continuing education courses . . . The follow-
ing dental continuing education courses will be offered
in December 1978;
National Naval Dental Center, Bethesda, Md.
Endodontics 4-6 Dee 1978
Comprehensive Dentistry 11-14 Dec 1978
Eleventh Naval District, San Diego, Calif.
Fixed Partial Dentures
4-6 Dec 1978
U.S. Army Institute of Dental Research, Walter Reed
Army Medical Center, Washington, D.C.
Preventive Dentistry 4-7 Dec 1 978
Letterman Army Medical Center, San Francisco, Calif.
Restorative Dentistry 4-7 Dec 1 978
Requests for courses administered by the Comman-
dant, Eleventh Naval District, should be submitted to:
Commandant, Eleventh Naval District (Code 37), San
Diego, Calif. 92132. Applications for other dental con-
tinuing education courses should be submitted to:
Commanding Officer, Naval Health Sciences Education
and Training Command (Code 5), National Naval Med-
ical Center, Bethesda, Md. 20014. Applications should
arrive six weeks before the course begins.
AFIP courses offered • . . The Armed Forces Institute
of Pathology will offer the following courses:
Seminars in Diagnostic Radiology 13-17 Nov 1978
These seminars are designed to offer radiology practitioners a sum-
mary of the most important morphological principles that underlie the
evaluation of roentgenologic signs. Materials have been carefully
chosen to achieve maximum radiologic-pathologic correlation in the
elucidation of disturbed morphology as seen on roentgenograms.
Applicants should be members of the Medical Corps
of the Armed Forces or federal services, or civilians
with specialty training in radiology.
Legal Medicine Symposium 14-16 Nov 1978
This course is designed to consider the legal problems developing in
the practice of medicine. Risk management and liability control will
be emphasized. Systems, organizational structures and accountabili-
ties will also be considered. Programs of prevention, aimed at re-
ducing frequency and severity of hospital and medically related in-
juries, will be demonstrated by case illustrations. The various
presentations are primarily intended to orient hospital administra-
tive, medical, legal, and health insurance personnel to the need for
more intensive procedures and controls to eliminate injuries and in-
Applicants should be assigned to a medical or legal
facility or organization within the federal services. Fed-
eral hospital senior medical personnel or claims inves-
tigators are especially invited. Applications from other
qualified personnel will be considered on a space-
Basic Forensic Pathology 27 Nov-1 Dec 1978
This course is designed to provide basic training in the special field of
forensic pathology, as a supplement to military and civilian residency
training programs in pathology. Emphasis is placed on the applica-
tion of scientific methods to untoward effects of the interaction of man
and his environment. The material for this course is presented by
specialists in the fields of forensic sciences, law, and investigation
through illustrated slide lectures and demonstrations.
Applicants should be resident pathologists, or path-
ologists in the Medical Corps of the Armed Forces or
the federal services. Civilian pathologists, including
residents, may apply and be considered on a space-
Further information may be obtained by writing to
the Director, Armed Forces Institute of Pathology,
ATTN: AF1P-EDZ, Washington, D.C. 20306.
Patient services training course ... As a result of in-
creasing needs and demands of the Medical Depart-
ment patient services community, a new course of in-
struction has been established by BUMED to train
qualified officers for entry-level positions in Patient
Services Administration. The curriculum for this pro-
gram covers medical-records administration, alterna-
tive health benefits programs and beneficiaries, quan-
titative analysis in the health field, auditing and quality
assurance, patient disposition, decedent affairs, and
The five-week program will be conducted at the
Naval School of Health Sciences, Bethesda, Md., with
the first class of 15 Medical Service Corps officers
scheduled to convene on 10 Oct 1978.
Navy cocktail party at ACS meeting ... In conjunction
with the American College of Surgeons meeting in San
Francisco, Calif., there will be a Navy cocktail party
held on Wednesday evening, 18 Oct 1978, from 6:30 to
9:30, at the Marines' Memorial Club, 609 Sutter Street,
San Francisco. For more information contact: CAPT
R.M. Deaner, MC, USN, Chairman, Department of
Surgery, Naval Regional Medical Center, Oakland,
U.S. Navy Medicine
American board certifications
indicated in parentheses):
American Board of Anesthesiology
LCDR Robert E. Woodruff, MC, USNR
LT Richard H. Balzer, MC, USNR
American Board of Dermatology
CDR Kenneth G. Gross, MC, USNR
LCDR Lauren A. Daman, MC, USNR
LCDR Stephen W. Shewmake, MC, USN
American Board of Endodontics
CAPT Arthur E. Krzeminski, DC, USN
CDR George S. Foster, DC, USN
American Board of Family Practice
CDR William D. Craver, MC, USN
LCDR Thomas W. Coale, MC, USNR
LCDR Rafael K. Deramos, MC, USNR
LCDR Richard L. Harman, MC, USN
LCDR Robert W. Harrison, Jr., MC, USN
LCDR Mark Jacobs, MC, USN
LCDR Oliver K. Williams III, MC, USNR
LCDR George R. Wilson III, MC, USNR
LCDR James W. Wilson, MC, USNR
LT Warren T. Wilson, MC, USNR
American Board of Internal Medicine
CDR Richard G. Daly, MC, USN (Endocrinology and
CDR George A. Luiken, MC, USNR (Medical Oncology)
CDR Stanley I. Thompson, MC, USNR (Cardiovascular
LCDR Theodore W. Burns, MC, USNR (Gastroenter-
LCDR George R. Freeland, MC, USN (Gastroenter-
American Board of Ophthalmology
LCDR Warren L. Broughton, MC, USNR
LCDR Gregory W. Cobb, MC, USNR
LCDR Thomas O. Morris, MC, USNR
LT Fredric D. Young, MC, USNR
American Board of Oral and Maxillofacial Surgery
CDR Roger E. Alexander, DC, USN
LCDR Kenneth J. Davis, DC, USN
LCDR Harvard J. Van Belois, Jr., DC, USN
LCDR Robert J. Vosskuhler, DC, USN
(Subspecialties are American Board of Pediatrics
LCDR Charles B. Brett, MC, USN
LCDR Johnny H. Dalton, MC, USN
LCDR Stephen M. Golden, MC,
LCDR Ulf R. Hierlwimmer, MC, USNR
LCDR John E. Wimmer, Jr., MC, USNR (Neonatal-
American Board of Periodontology
CDR Dennis R. Ahl, DC, USN
CDR Charles H. Julienne, DC, USN
LCDR Richard R. Gartner, Jr., DC, USN
LCDR James T. Mellonig, DC, USN
American Board of Prosthodontics
CAPT Charles M. Johnson, DC, USN
CDR Edward J. Billy, DC, USN
CDR Mark E. Heilman, DC, USN
CDR Robert W. Hinman, DC, USN
LCDR Thomas A. Lynde, DC, USN
American Board of Surgery
CDR Edsel J. Aucoin, MC, USN
LCDR Martin S. Barber, MC, USN
LCDR Mitchell H. Goldman, MC, USNR
LCDR William R. Rowley, MC, USNR
LCDR John J. Stoltenberg, MC, USNR
LCDR Michael A. Watts, MC, USN
American Board of Urology
CDR George J. Gavrell, MC, USN
CDR Raza M. Khan, MC, USN
CDR Gordon R. MacDonald, Jr., MC, USNR
LCDR Jeffrey H. Kossow, MC, USNR
LCDR Donald E. Sawyer, MC, USNR
American Academy of Microbiology
CAPT Sam W. Joseph, MSC, USN
Army Board of General Dentistry*
CAPT James V. Gourley, DC, USN
CAPT Ronald K. Harris, DC, USN
CAPT John T. Stevens, DC, USN
CDR Richard B, Finger, Jr., DC, USN
CDR Glenn E. Gordon, DC, USN
CDR Dean D. Schloyer, DC, USN
CDR Gary W. Troutman, DC, USN
♦Recognition applicable to military services only
Volume 69, September 1978
The Medical School Liaison Officer
The complex nature of the Armed
Forces Health Professions Scholar-
ship Program places a high premi-
um on the development of effective
communication links with students
in the field. While the overall re-
sponsibility for this task rests with
the Surgeon General of the Navy, he
is ably assisted by a cadre of inac-
tive Reserve officers who serve as
Medical School Liaison Officers at
medical and osteopathic schools
throughout the United States.
Officers assigned to duty as Med-
ical School Liaison Officers are re-
cruited from among inactive Re-
serve officers of the Navy Medical
Department who hold faculty or
administrative appointments at
their respective schools. Officers
assigned to MSLO duties serve in
addition to their primary assign-
ments with Naval Reserve Units.
While so assigned, Medical School
Liaison Officers perform the follow-
• Act as the designated repre-
sentative of the Surgeon General of
the Navy at the medical school for
all matters pertaining to the Armed
Forces Health Professions Scholar-
• Maintain liaison with the Com-
manding Officer, Naval Health Sci-
ences Education and Training Com-
mand, on routine matters pertain-
ing to administration of the Armed
Forces Health Professions Scholar-
• Disseminate to Navy scholar-
ship students, on a regular basis, all
pertinent information, directives,
and other guidance from higher
• Remain responsive to the mili-
tary needs of scholarship students
and assist, where required, in all
communications between students
and higher authority via the chain of
• Provide a point of contact for
representatives of the Commander,
Naval Recruiting Command, in all
matters relating to the recruiting of
prospective applicants for the
Armed Forces Health Professions
Scholarship Program. Assist, when
requested, in promoting physician
direct appointment recruiting.
At press time, the following offi-
cers of the Navy Medical Depart-
ment were serving as Medical
School Liaison Officers for their
CAPT Walter C. Griggs, MC, USNR-R
CDR George Gifford, MC, USNR-R
U. OF MASSACHUSETTS
CAPT Charles I. Brink II, MC, USNR-R
CDR Bradley E. Brownlow, MC, USNR-R
U. OF CONNECTICUT
CDR John Haney, MC, USNR-R
LCDR James P. Crowley, MC, USNR-R
LT Joel Labow, MC, USNR-R
U. OF VERMONT
CAPT Thomas R. Kleh, MC, USNR-R
LCDR W.J. Paladine, MC, USNR-R
LCDR Carl Bersten, MC, USNR (Ret.)
NEW YORK MEDICAL
CAPT Kirk K. Kazarian, MC, USNR-R
SUNY AT BROOKLYN
CDR Sheldon Bleicher, MC, USNR-R
CDR Joseph W. Sokolowski, Jr., MC,
MEDICAL OF PENNSYLVANIA
CDR Frank I. Marlowe, MC, USNR-R
CDR Robert C. Knowles, MC, USNR-R
U. OF PENNSYLVANIA
RADM-Selectee John R, Senior, MC,
CDR George E. Ehrlich, MC, USNR-R
CAPT Frederic F. Primich, MC, USNR-R
NEW JERSEY COLLEGE OF MEDICINE &
CDR Norman Ende, MC, USNR-R
CASE WESTERN RESERVE
CAPT Alfred D. Heggie, MC, USNR-R
U. OF CINCINNATI
CAPT Thomas H. Joyce, MC, USNR-R
U.S. Navy Medicine
CAPT Herbert G. Hopwood, Jr., MC,
CAPT Sherman Ross, MSC, USNR-R
JOHNS HOPKINS U.
CAPT Gardner W. Smith, MC, USNR-R
CAPT George J. Hill, MC, USNR-R
EASTERN VIRGINIA MEDICAL SCHOOL
HMCS E.J. Morrison (Ph.D), USNR-R
U. OF VIRGINIA
CAPT Lockhart B. McGuire, MC, USNR-R
CAPT John D. Tolmie, MC, USNR-R
U. OF NORTH CAROLINA
CDR D.E. Widmann, MC, USNR-R
U. OF SOUTH CAROLINA
CDR Frank N. Boensch, MC, USNR-R
CDR Wilson B. Rumble, MC, USNR-R
MEDICAL OF GEORGIA
CAPT H. Turner Edmondson, MC, USNR-R
U. OF FLORIDA
CDR James J. Cerda, MC, USNR-R
U. OF MIAMI
CDR Ronald J. Hagan, MC, USNR-R
U. OF SOUTH FLORIDA
CDR James N. Endicott, MC, USNR-R
U. OF KENTUCKY
CDR Jesse Harris, MC, USNR-R
U. OF LOUISVILLE
CAPT Richard F. Greathouse, MC, USNR-R
CAPT Emerson Emory, MC, USNR-R
U. OF TENNESSEE
CAPT Joseph H. Miller, MC, USNR-R
CAPT Raphael F. Smith, MC, USNR-R
U. OF ALABAMA
CAPT Charles E. Herlihy, MC, USNR-R
U. OF SO. ALABAMA
CAPT Leland Edmonds II, MC, USNR-R
U. OF MISSISSIPPI
CAPT Frank J. Morgan, MC, USNR-R
LOUISIANA STATE U. AT NEW ORLEANS
CAPT Roy H. Barnes, MC, USNR-R
LOUISIANA STATE U. AT SHREVEPORT
CAPT Norman L. Mauroner, MC, USNR-R
CDR William A. Martin, MC, USNR-R
U. OF ARKANSAS
CDR Jerry L. Thomas, MC, USNR-R
CAPT Paul B. Radelat, MC, USNR-R
U. OF TEXAS AT GALVESTON
CDR Daniel L. Creson, MC, USNR-R
CAPT Joseph R. Sasano, Jr., MC, USNR-R
U. OF OKLAHOMA
CDR Lawrence D. Amick, MC, USNR-R
CDR James Jackson, MC, USNR-R
U. OF MICHIGAN
RADM Park W. Willis, MC, USNR-R
LCDR John M. Doty, MSC, USNR-R
U. OF CHICAGO
CDR Stanton Polin, MC, USNR-R
CAPT William Ertl, MC, USNR-R
CDR Mario D. Oriatti, MC, USNR-R
LCDR John K. Hurley, MC, USNR-R
U. OF WISCONSIN
CDR Thomas D. France, MC, USNR-R
U. OF IOWA
CAPT Peter R. Jochimsen, MC, USNR-R
CAPT Harry Bisel, MC, USNR-R
U. OF MINNESOTA AT MINNEAPOLIS
CAPT Richard Woellner, MC, USNR-R
U. OF SOUTH DAKOTA
CDR James K. Jackson, MC, USNR-R
U. OF MISSOURI AT COLUMBIA
CDR William C. Allen, MC, USNR-R
SAINT LOUIS U.
RADM Matthias Backer, Jr., MC, USNR-R
U. OF KANSAS CITY
CDR James H. Chapman, MC, USNR-R
U. OF NEBRASKA
CDR Wm M. Berton, MC, USNR-R
U. OF COLORADO
RADM Ben Eiseman, MC, USNR-R
U. OF ARIZONA
CAPT James A. Austin, MC, USNR-R
CAPT George H. Mertz, MC, USNR-R
U. OF CALIFORNIA AT IRVINE
CDR Glenn W. Fowler, MC, USNR-R
U. OF CALIFORNIA AT LOS ANGELES
CAPT Harry T. Wright, Jr., MC, USNR-R
U. OF CALIFORNIA AT SAN DIEGO
CDR Kenneth M. Moser, MC, USNR-R
U. OF SO. CALIFORNIA
CAPT James T. Helsper, MC, USNR-R
CAPT Harry T. Wright, Jr., MC, USNR-R
U. OF UTAH
LCDR William C. Vincent, MC, USNR-R
U. OF CALIFORNIA AT DAVIS
CAPT Walter A. Tatge, MC, USNR-R
U. OF CALIFORNIA AT SAN FRANCISCO
CAPT Richard J. Bartlett, MC, USNR-R
CAPT Franklin G. Ebaugh, MC, USNR-R
U. OF OREGON
CAPT Richard M. Bernard, MC, USNR-R
U. OF WASHINGTON
CDR James R. Hooley, DC, USNR-R
SCHOOLS OF OSTEOPATHIC MEDICINE
KANSAS CITY COLLEGE
LCDR James H. Chapman, MC, USNR-R
LCDR John R. Downs, MC, USNR-R
CAPT James J. Woodruff, MC, USNR-R
Volume 69, September 1978
Instructions & Directives
New Hospital Corpsman specialty established
In May 1974, BUMED approved the formal training of Ocular Technicians, and BUPERS ap-
proved the assignment of the NEC HM-8444 for this training. It was planned at that time that
the training of Advanced Ocular Technicians would be approved at such time as the manning
in NEC HM-8444 permitted. This manning has been attained, and BUMED has approved the
training of Advanced Ocular Technicians through on-the-job training (OJT). BUPERS has
approved assignment of the NEC HM-8445.
The following activities have been approved for establishment of an OJT Program for Ad-
vanced Ocular Technician, HM-8445:
• CO, NATNAVMEDCEN, Bethesda, Md.
• CO, NAVREGMEDCEN, San Diego, Calif.
• CO, NAVREGMEDCEN, Portsmouth, Va.
• CO, NAVREGMEDCEN, Oakland, Calif.
Designation of billets and realignment have been accomplished at headquarters level, effec-
tive April 1978.
Commanding officers should provide widest possible dissemination of the information and
changes included herein.
A number of NEC change recommendations have been received by BUMED, certifying
completion of OJT in advanced ocular technique. Each request will be evaluated to ensure that
the training received is officially recognized.
Commands that have HM-8445 requirements but are not authorized to conduct OJT will
have their requirements met by normal sea/shore rotation as qualified personnel become
All OJT in NEC HM-8445 initiated after 1 July 1978 must be in compliance with BUMED-
INST 1510. 10D.— BUMED Notice 1510 of 27 June 1978.
Mercury vapor hazard
The purpose of this notice is to provide a method for eliminating the mercury vapor hazard in
dental operating rooms that utilize the Denta-Vac air-operated vacuum system manufactured
by A-dec, Inc., 2601 Crestview Drive, Newberg, Ore. This device is used to remove debris,
saliva, amalgam scraps, etc., from the patient's mouth while dental procedures are being per-
Enclosure (1) of this notice provides detailed instructions for modifying the Denta-Vac to
prevent mercury vapor from being exhausted to the environment.
All Denta-Vacs presently installed in dental operating rooms aboard ships and at dental
clinics ashore should be modified. Without this modification, the Denta-Vac will exhaust
mercury vapors into the dental operatory. — BUMED Notice 6260 of 9 May 1978.
Transfer of health records to NPRC, St. Louis
Because of numerous reports of discrepancies in record-transfer procedures received by the
National Archives and Records Service, GSA, OPNAV has requested BUMED to direct correc-
10 U.S. Navy Medicine
In terms of the number of reports received, the Medical Department is one of the largest
offenders, compared with other Navy activities, in not following correct procedures for trans-
ferring health care treatment records to the National Personnel Records Center (NPRC) at St.
Louis, Mo. The following discrepancies are most frequently cited:
• Records intermix. Inpatient, outpatient, and emergency room treatment records of mili-
tary personnel and dependents have not been separated and are being shipped intermixed.
requiring the records of dependents and other supernumerary patients to be retained at NPRC
unnecessarily for 25 years beyond the normal disposal date.
• SF 135, Records Transmittal and Receipt. Advance notice copy not sent to NPRC at least 2
weeks prior to shipping data; obsolete SF 135 used; form not signed; required number of
copies not sent; description of records and years covered not entered on form; disposal author-
ity cited incorrectly or not cited; etc.
• Other. Standard shipping cartons not used; nominal (name) index to records not included
in shipment; records shipped to wrong address.
A properly conducted records disposition program is an essential function in the administra-
tion and cost-effective management of naval health care facilities. Local programs interface
with and directly affect the NPRC in maintaining an automated inventory system, storing
records, and providing prompt retrieval service. Medical Department records have a
long-term value to patients and are vital to protecting the interest of the Government.
Each discrepancy in the transfer of health care treatment records to NPRC results in delay
and a preventable loss of resources by the Medical Department. The National Archives and
Records Service, GSA, has advised that unless the deficiencies in records shipments received
from naval activities are corrected, NPRC will be directed to refuse acceptance. Records
shipped to NPRC with major deficiencies will be returned at Medical Department expense.
Effective immediately, ships and stations having medical personnel shall fully comply with
the detailed instructions on record transfer provided as enclosure (1) of this notice. — BUMED
Notice 5212 of 29 June 1978.
Yellow fever vaccine
Since 3 Jan 1978, the yellow fever vaccine previously produced and distributed by Merrell-
National Laboratories, Inc., has been manufactured by Connaught Laboratories, Inc., Swift-
water, Pa. 18370, and is being distributed by Elkins-Sinn, Inc., 2 Esterbrook Lane, Cherry
Hill, N.J. 08002. After 28 Feb 1978, Merrell-National was to cease all distribution; however,
because the expiration date of their vaccine is 28 Feb 1979, it may be available for administra-
tion through that date.
International certificates of vaccination against yellow fever before 28 Feb 1979 may list
either Merrell-National or Connaught under the heading "manufacturer," depending upon
the brand of vaccine administered. Certificates completed after 28 Feb 1979 must list Con-
naught as manufacturer; otherwise, the certificate is invalid and the traveler may have to be
revaccinated before entering those countries that require a valid certificate.— BUMED Notice
6230 of 18 April 1978.
Volume 69, September 1978 11
In good times and in lean ones, a 'can do' spirit
has been the program's hallmark
Naval Aviation Physiology
LCDR Terrence J. O'Leary, MSC, USN
During World War I — because the primary role of
naval aviation was antisubmarine warfare — most
Navy flying was done at low speed and low alti-
tude. As a result, there was little or no appreciation of
the stresses of high-altitude flight.
By the end of the war, however, aircraft were avail-
able that could attain an altitude of 25,000 feet. As
higher flights became more routine, the need for a sup-
plemental oxygen supply for pilots became apparent.
In 1927, a letter from the Chief of the Bureau of
Aeronautics indicated that 2,000 oxygen tanks that had
been purchased by the Navy in 1922 (probably for
welding purposes) could be used for aviation. (At that
time, oxygen was supplied to the aviator through a
pipestem hooked over his lip.)
In 1929, a memorandum endorsement from the
Director of Fleet Training to the Chief of Naval Oper-
ations emphasized the importance of supplemental
oxygen for high-flying pilots (/):
It is apparent that the use of oxygen at altitudes of 15,000 to 16,000
feet is not necessary for safety but is extremely desirable in that the
physical and mental capability of the pilot is increased. Above these
altitudes, the necessity for oxygen increases and the factor of safety
to personnel enters.
In February 1940 — with prewar naval activities on
the increase — the Medical Research Section of the
Bureau of Aeronautics recommended that facilities be
procured to provide oxygen indoctrination for all flying
personnel. Through lectures and training films, in-
struction was to be given on the effects of "anoxia"
(lack of oxygen) at altitude, and on the use of oxygen
equipment. Practical demonstrations were to be pro-
vided in low pressure chambers, where flight personnel
could experience firsthand the consequences of anoxia
and the benefits of supplemental oxygen.
In July of the same year, the Bureau of Aeronautics
approved installation of low pressure chambers at the
basic flight training schools at Pensacola, Corpus
Christi, Miami, and Jacksonville.
In May 1941, LT H. J. Rickard, MC, USNR, LT T. D.
Boaz, MC, USN, Pharmacist's Mate First Class H. G.
Leak, and Water Tender First Class J. Krohn were or-
dered by the Bureau of Navigation to proceed to the
Navy Department in Washington for two weeks' train-
ing as members of the Navy's first Altitude Training
This group spent the first week with the Experi-
mental Diving Unit at the Washington Navy Yard,
where there was a low pressure chamber, used primar-
ily for research and development, and staffed by quali-
fied divers. The group's second week was spent in
Boston at the Harvard School of Public Health, which
also had a low pressure chamber and was already train-
ing two Army flight surgeons in high-altitude
By June the four were in Pensacola, where they gave
a two-week course of instruction to prospective train-
ing-unit personnel from the other basic flight schools
and began the training of cadets.
Of the early altitude instructors, Williams and Barr
One of the major accomplishments of the . . . program during 1941
and 1942 was to dispel misconceptions concerning the use of oxygen.
It was commonly believed that breathing 100 percent oxygen was
harmful, that strong men did not need supplemental oxygen until
they reached comparatively high altitudes, and that only the
LCDR O'Leary is a naval aviation physiologist assigned to the
NNMC Branch Clinic, Washington, D.C., with additional duty to the
1099th Physiological Training Flight, Malcolm Grow USAF Medical
Center, Andrews AFB, Md. 20031.
Volume 69, September 1978
physically weak needed to use oxygen at low altitudes. To many, use
of oxygen at low altitudes was an admission of weakness and lack of
stamina. These misconceptions were so prevalent and firmly in-
grained that altitude training personnel soon found themselves sell-
ing the use of oxygen to aviation personnel.
Demonstrations were given in low pressure cham-
bers like the one at Pensacola, described by Boaz (4):
The chamber, which is cylindrical in shape, is 20 feet long, 8 feet in
diameter, and is divided into 2 compartments; the larger is 16 feet
long, containing 14 seats (7 along each side), and the smaller or lock
compartment being merely 4 feet long and containing 2 seats on each
side. The 2 compartments may be operated separately when the door
between them is secured. This is of importance for individuals who
become distressed during a simulated high-altitude run. They may be
transferred to the lock compartment and brought quickly to atmos-
pheric pressure while the others remain at the simulated high altitude
and complete the "flight,"
By late 1941, the four low pressure chambers origi-
nally ordered had become so overworked that six more
were procured for other air stations. (For oxygen train-
ing in fleet units, six mobile chambers were procured in
In November 1941, wrote Williams and Barr (3):
. . . plans were developed for a program of pilot declassification based
on each aviator's tolerance to anoxia, chilling, and air embolism . . .
During 1942 the Altitude Training Unit at Pensacola conducted in-
vestigations aimed at the establishment of measures of altitude toler-
ance. Reactions to hypoxia at altitudes of 18,000 and 18,500 feet were
studied . . . Installation of the first refrigerated low pressure chamber
was completed at Pensacola in December 1942.
Cadets had to demonstrate a tolerance for tempera-
tures as low as -30 q F while at a simulated altitude of
30,000 feet. Those showing lesser tolerances were lim-
ited to flying low-altitude aircraft.
A course of instruction in low pressure chamber
technology, leading to the designation "low pressure
chamber technician," was established in 1941 for hos-
pital corpsmen (pharmacist's mates), and Altitude
Training Units began giving the course in 1942. In
December 1943, the first classes of WAVE corpsmen
began this training, so they could replace male corps-
men needed for fleet assignments.
Pollard (5) wrote that there were 10 medical officers
trained at Pensacola in 1942 "as instructors to in-
augurate low pressure chamber training at their
respective duty stations. Also., H-V(S) officers were
trained as instructors."
"H-V(S)," for "Hospital Corps-Volunteer (Special-
ist)," was a designation given to certain officer special-
ists brought into the Navy in World War II. These
■y^ 5 .▼ JM
^^^^^ s ^PSi^fc^
Aviation cadets at work in NAS Pensacola's refrigerated
low-pressure chamber, installed in December 1942.
H-V(S) officers were the predecessors of Medical Ser-
vice Corps aviation physiologists. At the time, however,
they were designated "environmental physiologists."
Ensigns Wilson C. Grant, Arthur H. Smith, and
Daniel T. Watts formed the first class of physiologists
to receive altitude training,
ENS Smith arrived at Pensacola in April 1942, a
month early for training, and was temporarily assigned
to work with LT Peckham, an aviation psychologist who
was developing a night vision training program.
Of his subsequent altitude indoctrination, Smith
says, "Nobody talked to us — we just learned by OJT."
Not until two or three classes later was a formal curric-
In December of that year, Smith was transferred to
MCAS Cherry Point, N.C., to establish an Altitude
Training Unit there. Subsequently he was assigned to
NAS Jacksonville, then to MCAS Santa Barbara, where
he served as the night vision training officer until
For Grant there are some vivid memories of Pensa-
cola in 1942.
One is of the visit of First Lady Eleanor Roosevelt,
who arrived during an inspection tour to learn where
women might fit into the Navy training program.
While at Pensacola she went through a low pressure
U.S. Navy Medicine
chamber flight on which ENS Grant was an observer.
The original intention was to take Mrs. Roosevelt on a
"flight" to only a few thousand feet; however, despite
lengthy explanations of potential discomforts, she in-
sisted on sharing the experience of the student pilots.
Another memory is an unhappy one, for Grant was a
witness to the plane crash in which CDR Eric Liljen-
crantz— the Navy's first flight surgeon to die in an air-
craft accident — was killed. Grant had been flying in the
same aircraft on the flight just before the fatal accident.
After leaving Pensacola in December 1942, ENS
Grant served in the Altitude Training Unit at NAS
Norfolk for three or four months before becoming a line
officer. Eventually, he switched to PT boats, arriving in
the Philippines just as the war ended.
The third classmate, ENS Watts, had joined the Navy
as a line officer, in his rush to enter the war effort. After
three months' active duty at Key West, he became an
H-V(S) officer and was ordered to Pensacola in May
1942 for altitude training.
After a subsequent tour at NAS Alameda, he served
from early 1944 until 1947 at the Naval Air Experi-
mental Station, Philadelphia, carrying out some of the
early human-factors research leading to development of
the first Navy ejection seat. Two special visitors to the
station during that time were Charles Lindbergh and
James Doolittle, whom Watts laconically describes as
' ' characters — e specially Doolittle . "
Early in 1943, NAS Jacksonville's Altitude Training
Unit established a course of instruction leading to
the designation "oxygen officer." A few of the
students were physiologists, but most were pilots who
had been disqualified from flying, cadets who had not
completed flight training, and others.
Since at the time there was no such thing as a test
stand to check oxygen equipment, these people were
tasked with checking each pilot's equipment prior to
flight— and occasionally at altitude in an aircraft. They
were often assigned to an Altitude Training Unit; how-
ever, they spent most of their time with the squadrons.
Later, air-sea rescue and survival training was added
to the "oxygen officer" course, and the designation for
graduates was changed to "aviation equipment and
survival officer." A school similar to Jacksonville's was
established at Pensacola in 1944, and by the end of 1945
the two schools had trained more than 400 officers (3),
By 1943, rapid expansion of the aviation training and
pilot declassification program had begun making it
difficult for Altitude Training Units to comply with the
numerous directives they were receiving. Shortages of
trained medical personnel were occurring. Moreover,
ground- and flight-training syllabuses for cadets were
too crowded to allow enough time for the oxygen indoc-
trination courses and altitude classifications requested
by the Bureau of Aeronautics. In short, the program
was becoming a major administrative problem.
In April 1943, the Bureau of Aeronautics asked
BUMED to assume responsibility for the program, and
within a few months altitude training had become the
program's primary mission (J).
Describing developments during this period, Pollard
The Bureau of Medicine and Surgery established a Low Pressure
Chamber and Oxygen Section under its Division of Aviation Medicine
in June 1943 and subsequently administered the development of
training techniques, the conduct of high altitude training for the
training commands and the fleet, and provided trained instructors
and supervisory personnel. The conduct of the training at the local
level was placed under the direct supervision of the local senior
medical officer. Assistance was obtained from locally assigned junior
It should be noted that early in the program not all
Altitude Training Units had physiologists assigned. In
those that did, a flight surgeon was still directly in
charge, and the physiologist served as his assistant.
With the war at an end, the training of corpsmen as
low pressure chamber technicians was discon-
tinued in late 1945.
Summer 1946 saw a massive exodus of personnel
and, wrote Pollard (5), "aviation physiology training
collapsed due to the release of trained instructors from
But progress in the science of aeronautics— and the
advent of more sophisticated aircraft — assured that the
setback would be only temporary.
By this time the Navy was developing ejection seats
for its high-performance aircraft, and on 30 Oct 1946
former ENS Daniel T. Watts— by then a lieutenant
commander — was witness to the first live Navy ejection
from an airborne platform.
The aircraft was a JD-1, and the volunteer was LTJG
A. J. Furtek, who had been a qualified parachutist as
an enlisted man and had later become a naval aviator.
The ejection process was supposed to work like this:
After ejection had been initiated, a static line, attached
to the aircraft, was to open the main parachute, which
was attached to the ejection seat. When descent of the
seat had been slowed down, the occupant was to dis-
connect himself, fall away from the seat, and open his
After five perfect dummy trials, it was decided to try
a live firing. With the aircraft at about 10,000 feet,
flying at about 205 mph, Furtek began his ejection;
however, the main parachute failed to open completely.
To observers, Furtek seemed slow in getting out of the
seat, but he finally pushed himself out at about 1,500
feet above ground. He fell some 200 feet more before
getting his parachute open and landing safely.
ntil the establishment of the Allied Science Branch
of the Medical Service Corps in 1948, there was no
established career pattern in the Navy to attract
Volume 69, September 1978
At Pensacola, WAVES teach aviation cadets proper use of oxygen equipment (1943).
aviation physiologists," Pollard (5) wrote. He noted
that although flight surgeons tried to conduct aviation
physiology training, there were too few of them to do so
adequately. Thus, "the unavailability of instructors
was an important factor in the slow revitalization of
At the 1948 Naval Air Training Command Confer-
ence, according to Pollard, a "general strengthening of
the training was recommended, including the addition
of regularly scheduled refresher training for fleet
pilots." Still, the end of 1950 saw just four aviation
physiologists on active duty.
LT Elizabeth Reeves, stationed at North Island, was
the only physiologist who had come on board during
World War II and had remained on continuous active
duty. LTs Glenna Cahill, stationed at Jacksonville, and
Mary F. Keener, at Norfolk, had been asked to return
to active duty to help revitalize the program. CDR
Roland A. Bosee, at El Centro, had been a naval aviator
during World War II and had converted to aviation
physiology in 1947.
In early 1951, a 10-week course was conducted for the
first class of student "applied aviation physiologists"
in six years. The five graduates were LTJG Bill Archer,
assigned to Philadelphia; LTJG Kenneth Coburn, to
Pensacola; LTJG Tom Ferris, to Atlantic City; ENS
Harold Bower, to North Island; and ENS Morris
Damato, to Corpus Christi.
In March of that same year, BUMED accepted the
Navy's first portable ejection seat tower designed
exclusively for training purposes. The prototype was
installed at NAS North Island for evaluation by the
Altitude Training Unit, with LCDR Marvin Courtney
(MC), a flight surgeon, as project officer. Shortly
thereafter, ejection seat trainers were installed at all
training unit locations.
U.S. Navy Medicine
The first female aviation physiologist to enter the
program after World War II was ENS Nancy Murtagh,
who completed her training in fall 1951 and was as-
signed to NAS Alameda. She says she initiated the
push for hazardous duty incentive pay (HDIP) for
officers and enlisted personnel routinely making low
pressure flights, having begun her work on the HDIP
proposal around 1953.
In June 1954, a bill introduced in the Senate included
the statement that "duty as low-pressure chamber
inside instructor" entitled individuals assigned by
competent authority to HDIP. The resulting Career
Incentive Act of 1955 set the monthly HDIP for officers
at $110; for enlisted personnel at $55.
In early 1959, the Hospital Corps NEC of 8409 was
established for low pressure chamber technicians.
These individuals had to be qualified aviation medicine
technicians (AVTs) who had received on-the-job train-
ing with Altitude Training Units. (Around 1962, a for-
mal low pressure chamber technician course was
established for selected volunteers, and in 1963 the
designation for these individuals was changed to
"aviation physiology technician.")
In 1961 an ADDU billet— Head, Aviation Physi-
ology Branch— was established at BUMED, and
CAPT Mary F. Keener was appointed to Fill it.
(The billet became full-time in 1965 but was lost in 1976
because of personnel cuts following the Vietnam
Late in 1962, LCDR Harold Bower presented a pro-
posal to CAPT Clifford Phoebus, Commanding Officer
of the Naval Aerospace Medical Institute, Pensacola,
concerning the training of naval aviation physiologists.
Under the proposal, preflight and flight training would
be added to the curriculum — a measure that would
lengthen the course from ten weeks to nearly six
months. Also, naval aviation physiologists would be-
come designated aircrew members, rating flight pay
and the right to wear wings. The purpose of the pro-
posal was to ensure that the training physiologists pro-
vided would be oriented, not just to the low pressure
chamber, but to the real world of aviation.
In January 1963, LCDR Bower and CAPT Phoebus
presented the proposal at BUMED to CAPT Keener;
CAPT Merrill H. Goodwin, Assistant Chief for Aviation
Medicine; and CAPT Robert S. Herrman, Chief of the
Medical Service Corps — all of whom liked the idea.
In December 1965, LT Durward Rhoades, ENS Tom
Bird, and ENS Robert L. Smith became the first
aviation physiologists to complete the new flight-train-
ing syllabus. On 10 Jan 1966, the Secretary of the Navy
approved the designation of naval aviation physiolo-
gists as aircrew members. And on 12 April 1967, a
change in the U.S. Navy Uniform Regulations per-
mitted wearing of wings by designated naval aviation
Early in 1970, CDR Paul W. Scrimshaw— who had
relieved CAPT Keener at BUMED — called a meeting of
some of the senior aviation physiologists to standardize
Navy physiology training procedures and syllabuses.
The resulting changes went into effect in fall 1970 and
included expansion of the night vision lecture to cover
various aspects of visual problems, vertigo, and disori-
entation. Added to the oxygen equipment lecture was a
briefing on all pertinent items of aircrew protective and
In January 1975, LCDR David G. Smith (MSC) en-
tered the Aviation Safety Officers School at Monterey,
becoming the first of a growing number of naval
aviation physiologists in the Aeromedical Safety Oper-
ations (AMSO) program. Awareness of the need for
more emphasis on the medical aspects of aviation
safety — and recognition of the additional services the
naval aviation physiologist can provide — has made the
physiologist an integral part of the AMSO team.
Recent developments in aviation physiology have in-
cluded interservice programs with the Air Force.
In 1976, LCDR Terrence J. O'Leary (MSC), HM1
Billy J. Cox, and HM1 Claude Carroll became the first
naval aviation physiologist and aviation physiology
technicians to work in an Air Force training unit (at
Andrews AFB, Md.).
Simultaneously, CAPT John Graham, BSC, USAF,
became the first Air Force physiological training officer
to work in a Navy training unit (at Barbers Point,
In February 1977, HM2 John Lawlor, HM2 Jeffrey L.
Munson, HM2 James Neeley, and HM3 Marlon Evans
became the first aviation physiology technicians to be
trained by the Air Force (at Brooks AFB, Tex.).
The history of any program is a history of people.
The people in this program have always been will-
ing to take on the job at hand — with a can-do spirit
and with devotion to the U.S. Navy. Their spirit and
enthusiasm have brought growth to this program
while — in these times of austerity — others have not
fared as well.
1. West VR, Every MG, Parker JF Jr (eds): U.S. Naval Aerospace
Physiologist's Manual. NAVAIR 00-80T-99, 1972, pp 1-21.
2. Rickard HJ: Medicos in the stratosphere. Contact 1:12-17, Aug
3. Williams NE, Ban- NL: The History of the Medical Department
of the United States Navy in World War II. NAVMED P-5031, 1953,
4. Boaz TD: Low pressure chamber installed at the Naval Air
Station, Pensacola, Florida. US Nav Med Bull 40(2); 429-439, 1942.
5. Pollard JP: Some aspects of physiology training in naval
aviation. Milit Med 126:133-139, 1961.
Volume 69, September 1978
Hospital Corps Career Decision:
The Time Is Now!
If you're contemplating leaving
the Hospital Corps because you
think your advancement opportuni-
ties, educational pursuits, or
chances for travel and rewarding
assignments are stifled, think
Advancement. The chances for
advancement within the Hospital
Corps are increasing. The following
breakdown portrays the selection
and advancement of hospital corps-
men, E-4 through E-9, during the
most recent advancement cycle:
• E-9: 106 board eligible; 44
• E-8: 651 board eligible; 122
• E-7: 704 board eligible; 323
• E-6: 942 test takers; 381
• E-5: 2,198 test takers; 683
• E-4: 1,688 test takers; 1,688
As can readily be determined,
advancement within the Hospital
Corps is alive and well.
Education. The Hospital Corps
has 31 advanced schools available
for qualified men and women. The
training for health-care paraprofes-
sionals in today's Hospital Corps is
commensurate with — and in many
cases better than — civilian training.
The list of advanced studies below
is indicative of opportunities as they
are today and will be tomorrow:
Nuclear Submarine Medicine
Surface Nuclear Medicine
Clinical Nuclear Medicine
Advanced Hospital Corps
Physical /Occupational Therapy
Biomedical Equipment, Basic
Biomedical Equipment, X-ray
Biomedical Equipment, Electronics
Medical Deep Sea Diving
Many of the above courses of in-
struction are wide open to qualified
candidates. Among these are Nu-
clear Submarine Medicine; Ad-
vanced Hospital Corps; Preventive
Medicine; Optician; Biomedical
Equipment, X-ray; Biomedical
Equipment, Electronics; Pharmacy;
and Special Operations.
Corpsmen with certain technical
skills are paid extra money upon re-
enlistment and during their tours of
duty. These are generally the opera-
tional skills, such as Nuclear Sub-
marine Medicine, Special Opera-
tions, and Medical Deep Sea Div-
Several Hospital Corps schools
are affiliated with, and accredited
by, civilian colleges and universi-
ties, and students receive college
credit upon completion of the
Billets. Navy Hospital Corps bil-
lets are available in every state in
the Union and at many overseas
locations. Depending on skills pos-
sessed, pay grade, performance,
etc., hospital corpsmen can look
forward to rewarding tours of duty.
A recent survey revealed that ap-
proximately 75% of all assignments
were made based on the duty pref-
erences of the individual.
The Guard II program, soon to be
replaced by Guard III, allows quali-
fied hospital corpsmen literally to
select their next duty station as a
reenlistment incentive. This pro-
gram rewards good performance
and definitely allows the corpsman
to detail himself.
If you take into account:
• the opportunity for advance-
• the opportunity to acquire a
technical skill within the health-
• the opportunity to pursue your
• the opportunity to select your
• the opportunity to increase
• the opportunity to be a part of
the best health-care system in the
Armed Forces, and
• the opportunity to perform a
service to your shipmates —
The time to decide on a career in the
Hospital Corps is now!
— HMCM Marty Luchter, USN, Senior
HM Detailer, BUPERS
U.S. Navy Medicine
lui rtLuiNu itiis una
ROSTER-1 AUGUST 1978
Fallowing is a list of stuff medical end dental officers of major fleets and forces;
district medical and denial officers; commanding officers; executive officers: direc-
tors of administrative services: directors of clinical sendees; chief nurses of Medical
Department activities; division surgeons and dental officers of Marine divisions.
Marine aircraft wings, and Marine brigades.
C1NCPACFLT/CINCPAC(ADDU) RADMD.E. BROWN. JR., MC, USN (ADDU)
U ™™ FLT CAPTN.D. WILKIE. DC, USN (ADDU)
CINCPACFLT AO CAPT J. WOLF. MSC. USN
(COMTRALANT) RADM E.P. RUCCI MC USN
CINCLANT/CINCLANTFLT/CINCWESTLANT RADM J.B. HOLMES DC USN
QNO.ANTFLT AO CDR W. BRANSCUM, MSC, USN
SACLAN r A0 CDR W.I. CASLER. MSC, USN
CINCUSNAVEUR CAFTH.E. SHUTE, MC, USN (ADDU)
CAPT R.S. NOLF. DC, USN (ADDU)
COMNAVFORJAPAN CAPT B.L. JOHNSON, MC, USN (ADDU)
CAPTE.T. WJTTE. DC, USN [ADDU)
COMNAVLOCJSTICS RADM D.E. BROWN, JR., MC. USN
AO CDR C.A. ROPER. MSC. USN
COMNAVAIRLANT CAPT R.P, CAUDILL. MC, USN
CAFr S. W. PERAND, DC, USN (ADDU)
COMNAVAIRPAC CAPT F.E. DULLY, MC, USN
CAPT A.L. DAVY, DC, USN (ADDU)
AO LCDR C. SCHMUTZ. MSC, USN
COMSUBLANT CAPT B.J. BLANKENSHIP, MC. USN
COMSUBPAC CAPT R.T. LARSEN, MC. USN
CAPT N.D. WILKIE, DC, USN (ADDU)
CNET(NAS PNCLA) RADM R.L. BAKER, MC. USN (ADDU)
CAPTT.W. MC KEAN, DC, USN (ADDU)
AOCAPTS.D. BARKER, MSC. USN (ADDU)
CNATECHTRA (NAS MEMPHIS. TN) CAPT C.W. BRAMLETT, MC. USN (ADDU)
CAPT D.G. GARUER, DC, USN (ADDU)
AO LCDR W.F. BENEDICT, MSC, USN
CNAT (NAS CORPUS CHRIST], TX) CAPT T.J. TRUMBLE, MC. USN (ADDU)
COMNAVSURFLANT C APT W.M. PHILLIPS. MC, USN
CAPTC.E. BRANYAN. DC, USN (ADDU)
COMNAVSUKFPAC CAPT J. W. JOHNSON. MC, USN
CAPT R.E. THOMAS. DC. USN (ADDU)
AO LCDR R.W. BARNHILL, MSC, USN
COMNAVFORCARIB/COM ANTILLES DEF COMD .... CAPT P.C. GREGG, MC, USN (ADDU)
CAPT D.E. BARLOW. DC. USN (ADDU)
COMFAIRMED CAPT J.A. MC KINNON, DC, USN (ADDU)
COMICEDEFOR CAFL M.C. CLEGG. DC, USN (ADDU)
COMTRAWING 4 CAPT A.D. SORF.NSON. DC. USN (ADDU)
OPNAV CAPT C.A. BROWN. DC, USN (ADDU)
OFFNAVRF.SCH. WASHINGTON. DC CAPT J.F, KELLY. DC. USN (ADDU)
FIHST NAVAL DISTRICT
NAVREGMEDCLINIC, PORTSMOUTH. NH .
NAVREGMEDCEN, NEWPORT. RI
NAVREGDENCEN, NEWPORT. RI .
DMO CAPT V.L. STOTKA. MC, USN (ADDU)
DDO CAPT W.A. PETERSON. DC, USN
CO CDR D.W. REEVES, MSC, USN
XO LCDR D. MC DERMOTT. MSC, USN
SRNURSECDR M. BRAXMAN, NC, USN
. CO CAPT V.L. STOTKA, MC. USN
DCS CAPT CM. VOYLES, MC, USN
DAS CDR N.K. OWENS, MSC, USN
CH NURSE CAPT L. ROBINSON, NC, USN
CO CAPT W.A. PETERSON, DC, USN
DCS CAPT C.J. SCHULTZ, DC, USN
DAS LTJ.C. WANAMAKER. MSC, USN
THIRD NAVAL DISTRICT
SUB MEDICAL CENTER. NEW LONDON, CT .
SUBMEDRSCHLAB. GROTON, CT -
FOURTH NAVAL DISTRICT
DMO CAPT L.H. SEATON, MC, USN (ADDU)
AOLTD. SUTTLE, MSC, USN (ADDU)
. CO CAPT L.H. SEATON, MC. USN
DCS CAPT R.B. JOHNSON, MC, USN
DAS CAPT F.G.ANDERSON, JR., MSC. USN
CH NURSE CAPT A. BARKER, NC, USN
. CDR R.A. MARGULIES, MC. USN
NAVREGMEDCEN. PHILADELPHIA, PA .
NAVREGDENCEN. PHILADELPHIA, PA .
NAVAL MEDICAL MATERIAL SUPPORT
COMMAND, PHILADELPHIA, PA
FIFTH NAVAL DISTRICT .
NAVREGMEDCEN, PORTSMOUTH, VA .
NAVAL SCHOOL OF HEALTH SCIENCES,
NAVREGDENCEN, NORFOLK, VA .
NAVAL BASE, NORFOLK, VA
NAVAL OPHTHALMIC SUPPORT & TRAINING
ACT, WILLIAMSBURG, VA
DMO CAPT R.A. BAKER, MC. USN (ADDU)
DDO CAPT A.F, REID, DC, USN (ADDU)
AOLTJ.N. GALLIS, MSC. USN (ADDU)
CO CAPT R.A- BAKER, MC, USN
DCS CDR CT. CLOUTIER. MC, USN
DAS CAPT H.S. RUDOLPH, MSC, USN
CH NURSE CAPT A. FOLEY, NC. USN
CO CAPT A.F, REID, DC, USN
DCS CAPT H.E. FREEBURN. JR.. DC. USN
DAS LT O.J, SANTORE, JR., MSC, USN
. CO CAPT O, STALLINGS, MSC USN
XOLCDRR.P. LEGG, MSC, USN
. DMO RADM G-E. GORSUCH, MC, USN (ADDU)
D1R DENACTYS RADM J. B.HOLMES. DC. USN
AO LCDR R.M. CURRAN. MSC. USN (ADDU)
. . CO RADM G.E. GORSUCH, MC, USN
DCS CAPT J.W. HAYES, MC, USN
DAS CAPT D.E. SHULER, MSC, USN
CH NURSE CAPT M.P. BRENN AN. NC, USN
. OIC CAPT B.A.MC KAY, NC, USN
AO LT G. MURPHREE, MSC, USN
. . CO RADM J. B. HOLMES, DC, USN
DCS CAPT W.E. 0U1LTER, JR.. DC, USN
DAS CDR C.A. WESOLOWSKI. MSC. USN
. . RADM J.B. HOLMES, DC, USN (ADDU)
NAVHOSP, CHERRY POINT, NC .
NAVREGMEDCEN. CAPM LEJEUNE, NC .
NAVREGDENCEN, CAMP LEJEUNE, NC .
ENVIRONMENTAL AND PREV MED UNIT
TWO. NORFOLK, VA
CO CAPT, I. G. WILCOX, MSC, USN
XO CDR H.L. GOOCH, MSC, USN
. CO CAPT D.E. STILL, MSC USN
DCS CAPT W.W. HODGE, MC. USN
DAS LCDR J, W. BALDWIN, MSC USN
CH NURSE CDR E. CARSON, NC, USN
CO CAPT J.L. HUGHES, MC USN
DCS CAPT R.J. SEELEY, MC, USN
CH NURSE C APT T, PROTO. NC USN
. CO CAPT N.K. LUTHER. DC, USN
DCS CAPT T.L. WHATLEY, DC. USN
DAS LCDR R.J. LINDSAY. MSC, USN
. OIC CAPT H.J. CANDELA, MC, USN
AO LT H.T. BROWN. MSC, USN
COMNAVMARIANAS CAPT R.D. PRINCE, DC, USN (ADDU)
US. NAVMEDRSCHUNIT#3 .
CO CAPT R.H. WATTEN, MC. USN
AOLTD.L. WHEELER, MSC, USN
SR NURSE CDR S. ROSS, NC, USN
U.S. NAVHOSP, TAIPEI CO CDR CM. DAY III, MC, USN
SR NURSE LCDR C. ZERBATO, NC, USN
U.S. NAVMF.DRSCHUN1T #2. TAIPEI.
U.S. NAVREGMEDCEN. SUBICBAY. ROP ,
U.S. NAVREGDENCEN. SUBIC BAY, ROP .
. CO CDR K. SORENSEN. MC. USN
AO LCDR S.A. NESS, MSC, USN
CO CAPT R.A. PROULX, MC, USN
DAS CDR R.M. COAN, MSC, USN
CH NURSE CDR E. O'NEILL, NC, USN
. CO CAPT M.M. STEVENS, DC, USN
DCS CAPT J. F. LESSIG, DC, USN
DASLTN.E. CARROLL. MSC. USN
U.S. NAVHOSP, ROTA COCAPT J. E. WILSON. MC, USN
DAS CDR C.A. HARTMAN, MSC USN
CH NURSE CDR H. HOLBROOK, NC, USN
COMNAVACT. SPAIN CAPT G.B. CROSSMIRE, DC, USN (ADDU)
HEADQUARTERS MARINE CORPS AND FLEET MARINE FORCE
HEADQUARTERS, U.S. MARINE CORPS CAPT G.E. GRIFFIN II], MC, USN
CAPT F.R. RUL1FFS0N, DC USN
AOCDRG.S, HARRIS. MSC. USN
HEADQUARTERS, FMF ATLANTIC CAPT R.R. PALUMBO, MC, USN
FORDO CAPT R.S. DAVISON, DC, USN
AO LCDR R.F. COXE, MSC, USN
SECOND MARINE DIVISION SURGEON CAPT R.M. LEHMAN, MC, USN
SECOND FORCE SERVICE SUPPORT GROUP SECOND DENCO CAPT R.A. GASTON, DC, USN
SECOND FORCE SERVICE SUPPORT GROUP 22ND DENCO FORTRPS CAPT J. S. K1TZMILLER, DC,
AO LCDR M.T. MEANEY, MSC, USN
SECOND MARINE AIRCRAFT WING CAPT E.L. GEHRY, MC USN
SECOND FORCE SERVICE SUPPORT GROUP 12TH DENCO CAPT D.T, FENNER, JR., DC. USN
AOLT J. L.JOHNSON, MSC, USN
HEADQUARTERS, FMF PACIFIC CAPT R.W. JONES, MC, USN
FORDO CAPT P.C ALEXANDER. DC USN
AP CAPT L.W. GAY, MSC, USN
FIRST MARINE DIVISION CDR R.C. HODGES, MSC. USN
FIRST FORCE SERVICE SUPPORT GROUP FIRST DENCO CAPT B.F. KRESL, DC, USN
AO LCDR J.T. LEWIS. MSC, USN
FIRST MARINE AIRCRAFT WING CDR D.S. ANGELO, MC USN
THIRD FORCE SERVICE SUPPORT GROUP (DETA) . .. 1ITHDENC0 CAPT .I.E. MILLER. DC. USN
AO LT R.T. F1GURA, MSC, USN
FIRST MARINE BRIGADE CDR M.O. ABBOTT, MC, USN
21ST DENCO CAPT L.M. MULDROW, JR., DC, USN
AO LCDR W.M. MC CLANNAHAN, MSC, USN
THIRD MARINE DIVISION SURGEON CAPT D.R. HAULER, MC, USN
THIRD FORCE SERVICE SUPPORT GROUP THIRD DENCO CAPT R.E. CASSIDY, DC. USN
AO LCDR J.J. BIELAWSKI. MSC, USN
THIRD MARINE AIRCRAFT WING CAPT G.E. BALYEAT, MC. USN
FIRST FORCE SERVICE SUPPORT GROUP I3TH DENCO CAPT R.E. WILLIAMS, JR.. DC, USN
AO LCDR M. ICZK0WSK1, MSC, USN
FLDMEDSERVSCOL, CAMP PENDLETON CO CAPT W.H. JONES, MSC, USN
XO LCDR E.J. LOOS. MSC. USN
FLDMEDSERVSCOL, CAMP LEJEUNE CO CAPT E.J. STEWARD. MSC. USN
XOCDRJ.M, CORRELL, MSC, USN
— This roster was prepared by BUMED Code 312.
CUT ALONG THIS LINE
NATIONAL NAVAL MEDICAL CENTER.
NATIONAL NAVAL DENTAL CENTER.
NAVAL HEALTH SCIENCES EDUCATION AND
TRAINING COMMAND. NNMC. BETHESDA. MD .
NAVSCOLHELCAREADMIN. BETHESDA. MD .
NAVMEDRSCHINSTITUTE. BETHESDA, MD . .
NAVMEDRSCHDEVCOM. BETHESDA, MD . . .
ARMED FORCES INST OF PATHOLOGY.
ARMED FORCES RADIOBIOLOGY RESEARCH
INSTITUTE, BETHESDA. MD
NAVAL MEDICAL DATA SERVICE CENTER,
NAVHOSP. PATUXENT RIVER, MD .
NAVHOSP, QUANT1CO, VA .
U.S. NAVREGMEDCEN, NAPLES - .
U.S. NAVREGDENCEN. NAPLES .
U.S. NAVAL ENVIRONMENTAL AND PREV MED
UNIT HI. NAPLES
CORADM J.T. HORGAN, MC. USN
DCS CAPT M. N1EVES. JR., MC, USN
DAS CAPT H.P. MILLER, MSC, USN
CH NURSE CAPT H. FURMANCHIK. NC, USN
CO CAPT S.T. ELDER, DC, USN
DCS CAPT R.D, CULLOM. DC, USN
DAS CDR M.K. LAW, MSC. USN
. CO RADM S. BARCHET, MC. USN
XO CAPT D.M. ALLMAN, DC, USN
AO LCDK R.E. NEWMAN, MSC. USN
. CO CAPT W.J. AUTON, JR.. MSC, USN
XOCDRD.R. CRAIG. MSC, USN
COCAPTW.F. MINER, MC, USN
AO CDR R.A. MORIN, MSC, USN
CO CAPT J.D. BLOOM, MC, USN
EXEC ASST CDR W. SCHROEDER, MSC, USN
DIR CAPT E.C. COWART, JR.. MC. USN
DIR COL L.W.R. STROMBERG. USA
AO CAPT E.D. M ATIF.K, MSC. USN
COCAPTL.E. ANGELO, MSC, USN
XOLCDR K.W.GIBSON. JR., MSC, USN
CO CDR E.R. CHRISTIAN, MSC, USN
DCS CAPT J, P. SENN, MC, USN
DAS LT M.A. BLOME, MSC, USN
CH NURSE CAPT D.H. HOOKER, NC. USN
CO CDR J. R. ERIE, MSC, USN
DCS CAPT J. A. OLSEN, MC, USN
DASLCDRD.D. WILSON, MSC, USN
CH NURSE CDR M.F. HALL, NC, USN
. CO CAPT N.W. COOLEY, MC, USN
DCS CAPT J.V. SHARP, MC, USN
DAS CDR J, A. BOYLE, MSC, USN
CH N URSE CAPT C. S H EA , NC, USN
CO CAPT J. A. MCKINNON, DC, USN
DCS CAPT J.T. JANUS, DC. USN
DAS CDR P.T. RAY, MSC. USN
. OICCDR J.W. POUNDSTONE. MC, USN
AO LCDR D.E. ANDERSON. MSC, USN
U.S. NAVREGMEDCEN, YOKOSUKA .
U.S. NAVREGDENCEN, YOKOSUKA .
U.S. NAVREGMEDCEN, OKINAWA .
U.S. NAVREGMEDCEN, GUAM .
U.S. NAVREGDENCEN. GUAM .
CO CAPT B.L. JOHNSON, MC. USN
DCS CDR J. P. SMYTH. MC, USN
DAS LCDR T.F.. THOMAS, MSC. USN
CH NURSE CAPT D. CORNELIUS, NC. USN
. CO CAPT E.T. WITTE. DC, USN
DCS CAPT R.E. HOWE, DC, USN
DAS LCDR E.C. PIERSOL, MSC, USN
COCAPTC.S. LAMBDIN, MSC, USN
DAS CDR C, MOORE, MSC. USN
CH NURSE CAPT M. CONLEY. NC. USN
. CO CAPT M.C. CARVER, MC. USN
DCS CAPT R.G. SABLAN, MC. USN
DAS LCDR K.L. LASHLEY, MSC, USN
CH NURSE CDR F. FRAZIER. NC, USN
CO CAPT R.D. PRINCE, DC, USN
DCS CAPT H.CDEATON, DC. USN
DAS LCDR O.H. GRISHAM. MSC. USN
SIXTH NAVAL DISTRICT
NAVREGMEDCEN. CHARLESTON. SC .
NAVREGDENCEN. CHARLESTON, SC .
NAVAL BASE. CHARLESTON, SC . . .
NAVHOSP. BEAUFORT. SC
NAVREGDENCEN, PARRIS ISLAND, SC .
NAVREGMEDCEN, JACKSONVILLE, FL .
NAVREGDENCEN, JACKSONVILLE. FL .
NAVHOSP, KEY WEST, FL .
NAVREGMEDCEN, MEMPHIS, MILL1NGTON, TN .
NAVREGMEDCEN, ORLANDO. FL .
NAVREGDENCEN, ORLANDO. FL
NAVAEROSPREGMEDCEN, PENSACOLA, FL .
NAVREGDENCEN, PENSACOLA, FL .
NAVAEROMEDRSCHLAB. PENSACOLA. FL . .
NAVAEROSPACEMEDINST, PENSACOLA, FL.
DISEASE VECTOR ECOLOGY AND CONTROL
CENTER, JACKSONVILLE, FL
EIGHTH NAVA1 DISTRICT
NAVREGMEDCEN, CORPUS CHRISTI, TX ,
NAVREGMEDCEN. NEW ORLEANS. LA .
. . DMO CAPT I.J. WOODSTEIN, MC. USN (ADDU)
DDO CAPT R.G. GRANGER, DC, USN (ADDU)
AO LCDR R.K. GREEN, MSC. USN (ADDU)
. CO CAPT l.J. WOODSTEIN, MC, USN
DCS CAPT R.E. TOBEY, MC. USN
DASCDRG.M. ELLIS, MSC, USN
CH NURSE CAPT R. PAMPUSH, NC, USN
. CO CAPT R.G. GRANGER, DC. USN
DCS CAPT T.M. ALLENSWORTH, JR.. DC. USN
DAS LTD.C. DUNKLEMAN. MSC. USN
. CAPT R.G. GRANGER, DC. USN (ADDU)
. CO CAPT D.C. GOOD, MC, USN
DCS CAPT W.R. MULLINS, MC, USN
DAS CDR W. BLANKENSHIP, MSC, USN
CH NURSE CAPT B. SLATER, NC. USN
. CO CAPT H.J. SAZIMA, JR., DC, USN
DCS CAPT A. HERR, DC, USN
DAS LCDR L.R. MAASSEN, MSC. USN
. CO CAPT W.J. MCDERMONT.JR..MC, USN
DCS CAPTN.R. RAFFAELLY. MC. USN
DAS CAPT LJ. SCHAFFNER, MSC, USN
CH NURSE CAPT M.J. WALKER. NC. USN
. COCAPTE.E. MCDONALD, JR., DC, USN
DCS CAPT E.H. PLUMP, DC, USN
DAS CDR R.L. WENTWORTH, MSC. USN
. CO CAPT P.F. WELLS 11, MC, USN
DAS LCDR F.D.R. FISHER, MSC, USN
CH NURSE CAPT D. DUNN, NC, USN
. CO CAPr C,W. BRAMLETT. MC, USN
DCS CAPT G.C. BINGHAM, MC. USN
DAS CDR B.L. STEPHENS, MSC, USN
CH NURSE CAPT M. MAYNARD. NC, USN
. CO CAFr J.A. ZIMBLE, MC, USN
DCS CAPT W.A. SCHEFSTAD, MC. USN
DAS CDR L.H. TURBEVILLE. MSC. USN
CH NURSE CAPT J.M. REDGATE, NC. USN
. CO H.C. FUND, JR., DC. USN
DCS CAPT H.S. SAMUELS, DC. USN
DAS LCDR P.N. ACKLEY, MSC, USN
CO RADM R.L. BAKER, MC, USN
DCS CAPT N.D. BROUSSARD, MC, USN
DAS CAPT S.D. BARKER, MSC. USN
CH NURSE CAPT K. WILSON, NC, USN
CO CAPT T.W. MC KEAN, DC, USN
DCS CAPT S.E, PEPEK, DC, USN
DAS LCDR P.R. COWART. MSC, USN
CO CAPT R.E. MITCHEL, MC, USN
CO CAPT H.S. TROSTLE, MC. USN
XO CAPT D.J. BRIDEAU. MSC, USN
OICi.CDRL.L. SHOLDT, MSC, USN
AO LT B.R. FORO, MSC. USN
. DMO CAPT P.D. COOPER, MC. USN (ADDU)
DDO CAPT A.J. BARTOSH. DC. USN (ADDU)
CO CAPTT.J. TRUMBLE. MC, USN
DCS CAPT D.W. PEACE, JR., MC, USN
DAS CDR W.A, GODFREY, JR., MSC, USN
CH NURSE CAPT M, DONOGHUE, NC. USN
CO CAPT P.D. COOPER, MC, USN
DAS CAPT J. L. GRAVES, MSC, USN
CH NURSE CAPT B. NAGY.NC, USN
NINTH NAVAL DISTRICT .
NAVREGMEDCEN. GREAT LAKES. ]L .
NAVREGDENCEN. GREAT LAKES, 1L .
NAVHOSPCORPSCOL, GREAT LAKES, IL .
NAVENVIRHI.THCEN. CINCINNATI, OH .
DMOCAPTM.J. VALASKE, MC, USN (ADDU)
DIR DENACTY5 CAPTC.J. MC LEOD, DC. USN
AO ENS T.P. CORMIER, MSC, USN
CO CAPT M.J. VALASKE, MC. USN
DCS CAP'!' L.R. FOUT, MC, USN
DAS LCDS R.A, PAYTON, MSC, USN
CH NURSE CAPT E.M. PFEFFEE. NC. USN
. CO CAPT C. J , MC LEOD, DC, USN
DCS CAPT H.B. MC WHORTER, DC. USN
DAS CDR P.J. COLLIER, MSC, USN
COCAPTM.R, WIRTHLIN, JR., DC, USN
. COCDRC.J.THEISEN, JR., MSC. USN
XO LCDR F. BRIAND, MSC, USN
SR NURSE CDR P. FLEURY, NC. USN
. OIC CAPT T.N, MARKHAM, MC, USN
MED ADM OFF LT F.C. HARDY, MSC, USN
TENTH NAVAL DISTRICT
NAVHOSP, GUANTANAMOBAY .
COMNAVB GU ANTAN AMO BAY
NAVHOSP, ROOSEVELT ROADS, PR .
NAVREGDENCEN, ROOSEVELT ROADS. PR .
ELEVENTH NAVAL D1STHICT
NAVREGMEDCEN, CAMP PENDLETON. CA .
NAVREGDENCEN, CAMP PENDLETON, CA .
NAVREGMEDCEN, LONG BEACH, CA
NAVREGDENCEN. LONG BEACH. CA .
NAVAL SCHOOL OF HEALTH SCIENCES,
SAN DIEGO, CA
DMO CAPT P.C.GREGG, MC. USN (ADDU)
DDOCAPT D.E. BARLOW, DC. U?N (ADDU)
CO CAPT R.P. BISHOP, MC. USN
DAS LCDR R. REL1NSKI, MSC. USN
CH NURSE CDR F. DAVISON, NC, USN
DO CAPT J. R. BOHACEK, DC. USN (ADDU)
CO CAPT P.C. GREGG, MC, USN
DAS CDR H.B. LEVANDOWSKI. JR-, MSC, USN
CH NURSE CAPT C. FINN, NC, USN
CO CAPT D.E. BARLOW, DC. USN
DCS CAPT R.A. MURPHY, DC, USN
DASLT W.M. MILLS. MSC. USN
DMO RADM J.W. COX, MC. USN (ADDU)
DIRDENACTYS RADM W.L. DARNALL, JR..
AO CDR J. B. KNIGHT. MSC. USN (ADDU)
CO CAPT CH. LOWERY, MC. USN
DCS CAPT D. RE1D, MC, USN
DAS CAPT F.C. P1TTINGT0N, MSC, USN
CH NURSE CAPT P. PORTZ, NC, USN
. CO CAPT WE. SUGG, JR., DC, USN
DCS CAPT J. D. MAHONEY. DC, USN
DAS LCDR J. D. GALBREATH, MSC, USN
CO CAPT Q.E. CREWS, MC, USN
DCS CAPT E.E, FREEMAN, MC, USN
DAS LCDR D.N. BENANDER, MSC, USN
CH NURSE CAPT A. WILLIAMS. NC, USN
. CO CAPT H..W. HODSON. DC, USN
DCS CAPT F.A. PAPERA, DC, USN
DASLTG.R. HARRINGTON, MSC. USN
. COCAPTW.E. MCCONVILLE, MSC. USN
XOCDRG.E. HAMMETT. MSC, USN
SR NURSE CAPT M, PERLOW, NC. USN
ENVIRONMENTAL AND PREV MED UNIT #5.
SAN DIEGO. CA
NAVHOSP. PORT HUENEME, CA .
NAVREGMEDCEN. SAN DIEGO. CA .
OIC CAPT S.J. KENDRA. MC, USN
AO LT D.R, GRAY. MSC. USN
CO CDR .I.E. JOHNS. MSC, USN
DCS CAPT T.E. CARSON. MC, USN
DAS LCDR S.J. PROFITA, MSC, USN
CH NURSE CDR C, BELEZOS. NC, USN
CO RADM J.W. COX. MC, USN
DCSCAFTJ.S, CAS5ELS.S, MC, USN
DAS CAPT E.N. BUCKLEY, MSC, USN
CH NURSE CAPT F. SHEA. NC, USN
NAVREGDENCEN, SAN DIEGO, CA .
CO RADM W.L. DARNALL. JR., DC, USN
DCS CAPT E.J. HEINKEL, JR., DC, USN
DAS CDR W.E. GROCE. MSC. USN
NAVHLTHRSCHCEN, SAN DIEGO, CA
COMNAVBASE, LOS ANGELES DOCAPTH.W. HODSON. DC. USN (ADDU)
CO CAPT R.H. RAHE, MC, USN
XO LCDR W. FERRIS, MSC, USN
TWELFTH NAVAL DISTRICT DMO RADM W.M. LONERGAN, MC, USN (ADDU)
NAVREGMEDCEN, OAKLAND, CA CO RADM W.M. LONERGAN, MC, USN
DCS CAPT L.U, PULICICCHIO, MC, USN
DAS CAPT H.H. SOWERS, MSC, USN
CH NURSE CAPT L, PETERSON, NC, USN
COMPATWINGSPAC MFT DO CAPT W.C. SULLIVAN, DC, USN (ADDU)
NAVHOSP. LEMOORE, CA CO CAPT J.J. PALMER, MSC, USN
DCS CAPT E.L. BINGHAM, MC, USN
DAS CDR F. TEAGUE, MSC, USN
CH NURSE CD" J.BARNES. NC, USN
NAVREGDENCEN. SAN FRANCISCO, CA CO CAPT J. E. HYDE, DC, USN
DCS CAPT R.P. MORSE, DC, USN
DAS CDR G, RAMIREZ, MSC, USN
NAVD1SVECTECOLC0NCEN, ALAMEDA, CA OIC LCDR R.V. PETERSON. MSC, USN
AO LT T.W. WILDER, MSC, USN
NAVBIOSCILAB, OAKLAND. CA CO CAPT J.F. PR1BN0W. MSC, USN
AO LTJG J-D. FORD, MSC, USNR
THIRTEENTH NAVAL DISTRICT .
NAVREGMEDCEN, BREMERTON, WA .
NAVREGDENCEN, BREMERTON, WA .
NAVHOSP, WHIDBFY ISLAND, OAK
NAVCL1N1C. NSA, SEATTLE, WA .
FOURTEENTH NAVAL DISTRICT .
NAVREGMEDCL1NIC, PEARL HARBOR, HI .
NAVREGDENCEN, PEARL HARBOR, HI ,
DMO CAPT R.C. ELLIOTT, MC, USN (ADDU)
DDOCAPTRG. THOMPSON, DC, USN (ADDU)
AO LCDR K.W. SHAFFER. MSC. USN (ADDU)
CO CAPT R.C. ELLIOTT, MC, USN
DAS CDR D.D. PALMER, MSC, USN
CH NURSE CAPT M,G. STEWART, NC, USN
CO CAPT R.G. THOMPSON, DC, USN
DCS CAPT J.F. SCOTT. DC, USN
DAS LT C.E. LAND. MSC. USN
COCDRG.W. BALDAUF, MSC, USN
DCS CAPT D.W. COWHERD, MC, USN
DAS CDR P.O. DILLEY, MSC, USN
CH NURSE CDRK. KENDALL, NC. USN
CO CAPT R.L, SURFACE, MSC, USN
XO LCDR K.W. SHAFFER, MSC, USN
SR NURSE LCDR V.E. BOYCE, NC, USN
DMO CAPT A.L, SOLGAARD, MC, USN (ADDU)
DDOCAPTN.D. W1LKIE, DC, USN (ADDU)
AO CDH D.R. FERGUSON, MSC, USN (ADDU)
CO CAPT A.L. SOLGAARD, MC, USN
DAS CDR D.R. FERGUSON, MSC, USN
SR NURSE CAPT A. GOMES, NC, USN
CO CAPT N.D. WILKIE, DC. USN
DCS CAPT A.D. L01ZEAUX, DC, USN
DAS LCDR J. D. DELAUGHTER, MSC, USN
NAVMEDADMUNIT TRIPLER ARMY HOSP.
HONOLULU, HI OIC
ENVIRONMENTAL AND PREVENTIVE MEDICINE
UNIT #6, PEARL HARBOR, HI OIC CAPT T.R. BYRD, MC, USN
NAVAL DISTRICT, WASHINGTON, DC .
NAVHOSP, ANNAPOLIS. MD
AO LT JM. CONSENZA. MSC. USN
DMO RADM J.T. HORGAN. MC, USN (ADDU)
DDO CAPT ST. ELDER, DC, USN (ADDU)
CO CAPT J. D. PRUITT, MSC, USN
DCS CAPT W,J, WAGNER, MC. USN
DAS LCDR L.L. MOORE, MSC, USN
CH NURSE CAPT L. N1CKERS0N, NC, USN
Not content simply with caring for
inpatients, nurses and hospital
corpsmen at NRMC San Diego are
volunteering off-duty time to teach
cardiopulmonary resuscitation tech-
niques to crewmembers of afloat
commands in the area.
The CPR presentation is offered
in conjunction with the American
Heart Association and leads to certi-
fication by that organization. To
date, the San Diego project has re-
sulted in certification of more than
In the photo, LCDR Elizabeth D.
Kunc (NC), teaches CPR basics to
crewmembers of the USS Blue
When LT Jerry W. Rose (MC) com-
pleted his internship at NRMC Oak-
land in June, he got a bonus: the
wings of a Navy flight surgeon.
Rose had enrolled in the six-
month flight surgeon program
(which includes six weeks of flight
training) as an elective during his
senior year of medical school at the
University of Washington.
Normally, the program is open
only to physicians who have already
completed a one-year internship.
According to records at the Naval
Aerospace Medical Institute, Pen-
sacola, Rose is the first medical stu-
dent to complete the flight-surgeon
When he finished flight school in
December 1976, Rose was pre-
sented a certificate and the promise
that he would be designated a naval
flight surgeon when he completed
the program's usual prerequisites.
A year and a half of waiting paid
off on June 30, when Rose's wife,
Barbara, pinned on his wings.
Shortly thereafter, Rose was on his
way to Okinawa, where he will be
flight surgeon for the First Marine
In the case of this giant tooth, all
that glitters is indeed gold: it repre-
sents the response of the Naval
Regional Dental Center, Camp
Pendleton, Calif., to this year's
Navy Relief Fund Drive.
CAPT B. C. Sharp (DC), com-
manding officer, and LCDR J. D.
Galbreath (MSC) point to the
achievement: $2,534 pledged for
Navy relief— more than four times
the assigned $600 goal.
Rose: On the wing
Kunc: CPR training for seagoers
Volume 69, September 1978
Sharp & Galbreath: Goldfingers
Bezoar: An Unusual Complication of Surgery
for Dumping Syndrome
LCDR Gerald S. Weinstein, MC, USNR
Interposition of a reversed segment of jejunum be-
tween the gastric remnant and the duodenum has been
shown to be an effective treatment for dumping syn-
drome. This article describes a previously unreported
complication of this procedure: development of a phyto-
F.B., a 38-year-old white male with a 20-year history
of duodenal ulcer disease, had undergone truncal va-
gotomy and pyloroplasty in 1974.
Immediately following that operation, the patient
developed severe dumping syndrome accompanied by
hypoglycemia. Despite antidumping diets, he had
episodes of flushing, tachycardia, diarrhea, and pros-
tration six to ten times per day. During these episodes,
his blood glucose levels were found to be between 20
and 32 mg/100 ml.
On 10 Mar 1977, the patient underwent antrectomy
and reversed jejunal segment interposition, as de-
scribed by Herrington and Sawyers (1,2). A 10-cm
segment of jejunum was interposed between the gastric
remnant and the duodenum.
The patient's postoperative course was complicated
by an episode of sepsis, thought to be due to an anasto-
motic leak. He responded dramatically to antibiotics
and was discharged on the 25th postoperative day. The
dumping syndrome and hypoglycemia were completely
abolished by the operation, and the postoperative
glucose tolerance test was normal.
Subsequently, the patient developed early satiety
From the Department of Surgery, NRMC Newport, R.I.
and delayed gastric emptying. Fiberoptic gastroscopy
showed narrowing of the gastrojejunal anastomosis. It
was felt that the patient had developed a stricture sec-
ondary to an anastomotic leak.
Revision of the anastomosis and Stamm gastrostomy
were performed on 15 June 1977. The patient recovered
well from this procedure and remained asymptomatic
for approximately two months, when he became inca-
pacitated by manometry-proved diffuse esophageal
spasm, refractory to conservative management. On 6
Sept 1977, he underwent extended esophagomyotomy.
Fiberoptic gastroscopy at that time was normal.
Several weeks following this third procedure, the pa-
tient complained of post-thoracotomy pain and a "ball-
like" feeling in his abdominal wall. Intercostal nerve
block relieved the post-thoracotomy pain, but the "ball-
like" feeling remained.
On 21 Nov 1977, the patient was readmitted to the
hospital with severe abdominal pain. Chest and ab-
dominal X-rays showed the presence of a large food
mass in a greatly distended gastric remnant (Figure 1).
A gastrostomy tube was reinserted under local anes-
thesia, and a solution of commercial meat tenderizer
(one teaspoon in 30 ml of water) was instilled through
the tube every four hours.
Within eight hours, the mass had decreased in size,
and large pieces of undigested food material could be
extracted from the gastrostomy tube.
By the next day, the food mass was approximately
one half its initial size (Figure 2). This decrease in size
was associated with relief of the "ball-like" feeling.
The food mass was gone by the fifth day (Figure 3).
An upper G.I. series performed prior to the patient's
discharge showed no evidence of obstruction or exces-
sively delayed gastric emptying.
U.S. Navy Medicine
FIGURE 1. A large mass of undigested food greatly distends
the gastric remnant.
On careful questioning, the patient recalled eating as
many as six to eight nectarines per day for four to six
weeks following his esophagomyotomy.
FIGURE 2. After one day of therapy with commercial meat
tender izer, the food mass is reduced to approximately one
half its initial size.
The purpose of reversed jejunal segment interposi-
tion for dumping syndrome is, of course, to slow gastric
emptying. Although it may be expected that such a
situation may provide the setting for formation of a
phytobezoar, such an occurrence has not been
Enzymatic treatment with commercial meat tender-
izer, which contains papain, was quite successful and
demonstrates that nonoperative therapy is possible.
Patients of this sort should be cautioned against
eating large amounts of fleshy fruits or other high-resi-
1 . Herrington JL, Sawyers JL: A new operation for the dumping
syndrome and post-vagotomy diarrhea. Ann Surg 175:790, 1972.
2. Sawyers JL, Herrington JLr Superiority of antiperistaltic
jejunal segments in management of severe dumping syndrome. Ann
Surg 178:311, 1973.
Volume 69, September 1978
FIGURE 3. Five days after patient's admission, food mass is
entirely gone. Note the presence of the gastrostomy tube.
Treatment of Chronic Bacterial Prostatitis
LCDR Donald F. Lynch, Jr., MC, USN
Chronic bacterial prostatitis is the most common
cause of relapsing urinary tract infection in the adult
male (/). It is encountered in both the younger active-
duty population and the older retired populations, and
thus presents a therapeutic challenge not only to the
hospital-based urologist, but also to the dispensary or
ship-based general medical officer.
Chronic bacterial prostatitis is always caused by an
infectious organism, although this is frequently difficult
to document. The disorder is characterized by variable
urethral, perineal, or suprapubic pain; mild dysuria;
decreased stream caliber; and dribbling. Mild discom-
fort with ejaculation may be present. Urethral dis-
charge—usually clear and often scanty— is present and
is often most noticeable in the morning. There is no
Physical Findings are variable, but mild tenderness
and bogginess of the prostate are frequently noted.
There is always expressible prostatic secretion, which
usually contains more than 40 to 60 white blood cells
per high-power field.
An additional characteristic is a history of multiple
previous attempts at treatment, usually with transient
improvement or temporary cure, but with eventual re-
currence of symptoms and findings.
Trimethoprim is a recently developed antibiotic that
acts against a wide variety of gram- negative and gram-
positive organisms by inhibiting folate synthesis. It has
been shown to have an affinity for prostatic tissue, and
high tissue concentrations can be obtained. When tri-
methoprim is combined with a sulfonamide, the activi-
ties of both drugs are enhanced. Because sulfamethox-
azole has a half-life similar to that of trimethoprim, it is
used with the latter in a commercially available drug
Preliminary indications that trimethoprim-sulfa-
methoxazole had been effective in the treatment of
chronic bacterial prostatitis prompted an evaluation of
this drug in our clinic population.
Materials and methods
Thirty-three patients, ranging in age from 23 to 72,
were treated for chronic bacterial prostatitis between
August 1975 and February 1977. All had histories of un-
successful previous treatment for this disorder.
Two methods of diagnosis were employed. Twenty-
three patients were diagnosed on the basis of positive
cultures of expressed prostatic secretions (EPS) or post-
TABLE 1 . Means of Diagnosis /Organism Cultured
Source No. of patients Organism cultured
TRIMETHOPRI SULFAMETHOXAZOLE GROUP
From the Department of Urology, NRMC San Diego, Calif. 92134.
Presented at the 25th Kimbrough Urotogical Seminar, Denver, Colo.,
7-11 Nov 1977.
(E. coll- 11)
(E. ooli- 4, Klebsiella- 1)
(E. ooli- 5)
(E. coli- 2)
U.S. Navy Medicine
prostatic-massage urines (VB3), as described by
Meares and Stamey (2). Ten additional patients were
diagnosed on the basis of irritative and obstructive
symptoms, prostate examination, urethral discharge,
and examination of the expressed prostatic secretions,
as modified after Chesley and Dow (J). This latter
method was referred to as the "classic picture" ("CP")
diagnosis, and was an attempt to reproduce diagnostic
conditions prevailing at small facilities lacking the bac-
teriologic equipment required to prove the diagnosis by
"Cure" was defined as resolution of symptoms,
clearing of urethral discharge and prostatic secretions,
and clearing of cultures.
"Improvement" was defined as clearing of cultures,
with partial resolution of symptoms.
"Failure" was defined as no change in symptoms, or
relapse to positive cultures, with recurrence of symp-
toms, within 6 months.
Two courses of therapy were utilized. One group of
patients received trimethoprim, 160 mg, and sulfa-
methoxazole, 800 mg, twice daily for 30 days. A second
group was treated with tetracycline, 0.5 gm, four times
daily for 30 days.
Followup time ranged from 9 to 25 months. Each pa-
tient was seen at the completion of therapy and at 3 and
6 months after treatment. Most have been followed
more than 12 months. VB3 cultures were obtained at
the completion of treatment and at the 6-month visit.
Twenty-four patients were treated with trimetho-
prim-sulfamethoxazole. Five additional patients were
allergic to sulfa, and 4 patients presented after having
tetracycline therapy initiated elsewhere. These 9
patients were treated with tetracycline. Of 23 patients
with positive cultures, 22 were due to E. Coli and 1 to
Klebsiella. The average colony count of the positive
cultures was 10 4 colonies. The distribution of patients,
by diagnosis and culture, is shown in Table 1.
The results of treatment are outlined in Table 2. Fif-
teen of 24 patients treated with trimethoprim-sulfa-
methoxazole were cured, and 3 noted improvement.
Two of 9 patients treated with tetracycline were cured,
with 1 noting improvement. The response of patients
diagnosed on the basis of the "classic picture" was
identical to that of those diagnosed by bacterial culture.
No drug reactions or other complications of treatment
TABLE 2. Results of Treatment
Cured Improved Failed Totals
The diagnosis of chronic bacterial prostatitis is
complicated by the variability of presenting symptoms
and the difficulties inherent in obtaining bacterial cul-
tures from the prostate. Differentiation between mild
acute prostatitis, abacterial prostatitis or prostatosis,
and chronic bacterial prostatitis may, at times, be im-
The results of other evaluations of trimethoprim-
sulfamethoxazole in the treatment of chronic bacterial
prostatitis are shown in Table 3. The variation in treat-
ment periods, ranging from 28 days to 12 weeks, makes
precise comparison difficult, but the results of the pre-
sent study are encouraging.
The culture techniques advocated by Meares and
Stamey are useful in documenting infection of the pros-
tate (2,4). The bacterial cultures obtained in this study,
using their techniques, are consistent with infection
patterns noted by other investigators (4.6. 7). Culture of
the semen rather than of expressed prostatic secre-
tions, while not utilized here, has been successfully
employed and should receive additional evaluation (5).
Drach has observed that trimethoprim was more ef-
fective in curing prostatitis due to gram-negative orga-
nisms than that due to gram-positive organisms (6).
The fact that only gram-negative organisms were cul-
tured from patients in this study may partly explain the
improved cure rate observed.
TABLE 3, Comparison with Other Studies
Chesley and Dow (1973)
McGuireand Lytton (1976)
Volume 69, September 1978
The "classic picture" diagnosis of chronic bacterial
prostatitis, while less scientific than diagnosis from
bacterial cultures, is still widely used (3,8). The finding
of white blood cells in the prostatic secretions, by itself,
has been shown to be an unsatisfactory criterion for
diagnosing chronic prostatitis (9,10). In the absence of
a dependable bacteriology laboratory, microscopic
examination of the prostatic secretions, combined with
a careful history and physical examination, can be
useful in making the decision to initiate therapy.
The mean age of the patients in the trimethoprim-
sulfamethoxazole group was 38 years. Cure was
achieved in 12 of 16 patients (75%) under 40 years of
age. Of the 8 patients over 40, 3 (38%) were cured.
More than half of the patients in Drach's study were
over 40 years old (6). Age was not addressed by other
investigators, but it is suspected that the preponder-
ance of these patients were over 40. In older patients,
the presence of prostatic calculi, benign prostatic
hypertrophy, or other lower urinary tract obstruction
can perpetuate infection and hamper therapy. The im-
proved cure rate achieved in the present study is prob-
ably a reflection of the large number of younger pa-
Although the data presented are limited, this study
suggests that the combination drug trimethoprim- sulfa-
methoxazole represents a major advance in the treat-
ment of chronic bacterial prostatitis. A 30-day course of
therapy can produce complete cure, especially in pa-
tients under 40, and long-term treatment with low
doses may afford relief in patients for whom complete
cure cannot be achieved. The results of this study imply
superiority of this drug regimen over the standard
tetracycline regimen that has been used for this dis-
1. Meares EM: Bacterial prostatitis vs "prostatosis." JAMA
2. Meares EM, Stamey TA: Bacterial localization patterns in
bacterial prostatitis and urethritis. Invest Urol 5:492-518, 196S.
3. Chesley AE, Dow D: Use of trimethoprim -sulfamethoxazole in
chronic prostatitis. Urology 2:280-282, 1973.
4. Meares EM: Prostatitis: a review. Urol Clin North Am 2:3-27,
5. McGuire EJ, Lytton B: Bacterial prostatitis: treatment with
trimethoprim-sulfamethoxazole. Urology 7:499-501, 1976.
6. Drach GW: Trimethoprim-sulfamethoxazole therapy of bac-
terial prostatitis. J Urol 111:637-639, 1974.
7. Drach GW: Prostatitis: man's hidden infection. Urol Clin North
Am 2:499-520, 1975.
8. Brannan W: Treatment of Chronic Prostatitis. Urology 5:626-
9. Bowers JE, Thomas GB: Clinical significance of abnormal
prostatic secretions. J Urol 79:976-982, 1958.
10. Bourne CW, Frishette WA: Prostatic fluid analysis and prosta-
titis. J Urol 97:140-144, 1967.
Notes from the I.G., Medical
Surplus equipment. In numerous
activities, equipment that has be-
come surplus to the needs of the
command is stored in various places
without an active disposal program.
It is recommended that commands
review their procedures for disposal
of equipment no longer required.
Uncollectable accounts. At some
commands, uncollectable accounts
for patient care have not been
properly followed up. The result has
been excessively high amounts in
"accounts receivable." It has been
determined advantageous that the
Naval Investigative Service (NIS) be
informed of the names of individ-
uals with deliquent accounts, since
the same individuals may possibly
pass bad checks in the commissaries
and exchanges or engage in other
activities of an illegal nature. There-
fore, we recommend that the names
of individuals with past-due ac-
counts be provided NIS for their in-
BMET and Public Works personnel.
We remind commands that, prior to
purchase of new equipment, BMET
or Public Works personnel (or both,
depending upon the type of equip-
ment) should receive training in the
operation and maintenance of this
In-service training programs. There
is a need for continued emphasis on
improvement of the enlisted In-Ser-
vice General Military Training Pro-
grams. In the development of these
programs, consideration should be
given to ensuring that:
• Only outstanding and highly
qualified personnel are assigned as
instructors, and that equally quali-
fied personnel are assigned as sub-
stitutes whenever the principal
instructor is unavailable.
• Lesson plans be submitted to,
and reviewed by, the In-Service
Training Officer, Nursing Education
Coordinator, or Chief of Service to
which the lesson plan refers to en-
sure appropriateness and validity of
• Local instructions on attend-
ance and excused absences are
• The In-Service Training Officer
and Nursing Education Coordinator
concurrently develop, organize, and
administer the program.
• Class schedules be prepared
and promulated to provide sufficient
lead-time notification to attendees
• Appropriate records of in-ser-
vice training be maintained to en-
sure required documentation of
eligibility for advancement in rate.
BUMEDINST 1510.8 is the appli-
— RADM Melvin Museles, MC, USN
U.S. Navy Medicine
ASBESTOS SURVEILLANCE . . . VADM Willard P.
Arentzen (MC), Navy Surgeon General, has announced
establishment of an expanded medical surveillance pro-
gram for all Navy uniformed and civilian personnel
potentially exposed to airborne asbestos.
In CY 1977, an estimated 14,000 Navy personnel
were examined to meet requirements of DOD Occupa-
tional Safety and Health Regulations. It is estimated
that as many as 70,000 civilian and 150,000 active-duty
personnel will be included in the new program, which
has been expanded to cover all present Navy civilian
and uniformed personnel who may have had past occu-
pational exposure to airborne asbestos, or who are
potentially exposed to low levels of akborne asbestos.
Implementation of the program will include hiring of
55 additional Medical Department personnel for Navy
medical care facilities and expenditure of approxi-
mately $1 .6 million in the first year.
In phase one of the program, all current uniformed
and civilian employees who may ever have been ex-
posed to asbestos will be identified by the completion of
a questionnaire. In phase two, those who have been
potentially exposed will be interviewed and receive a
medical examination, including recording of their occu-
pational and respiratory history, physical examination
of the chest, chest X-ray, and pulmonary function tests.
Personnel whose medical examinations show evi-
dence of lung change compatible with asbestos expo-
sure will have their medical records flagged for surveil-
lance with an annual medical examination for the dura-
tion of their federal service. Those whose question-
naires and interviews indicate a history of asbestos ex-
posure, but who show no present evidence of asbestos-
related physical change, will be scheduled for future
medical examinations at least once every five years. Be-
cause of the unique high-risk relationship between
smoking and exposure to airborne asbestos, all regular
smokers with an exposure history, as determined by the
survey, will be placed in the medical surveillance pro-
gram and receive annual examinations.
The Navy is adopting a "medical surveillance action
level" that will require medical examination for all in-
dividuals who, in the course of employment, are re-
quired to enter or work, "on a regular basis," in areas
containing airborne asbestos concentration of 0.5
fibers greater than 5 micrometers in length, per cubic
centimeter of air, as determined by phased contrast
microscopy. This means that more Navy people will be
monitored than would ordinarily be included under the
current standards for asbestos-exposed workers.
The new standards define "on a regular basis" as
exposure for 15 days in any calendar quarter, or 45 days
per year. Additionally, individuals exposed above a
"ceiling limit" of 10 fibers per cc of air at any time will
be placed in the medical surveillance program.
PAP SMEAR PROBLEM . . . Women who had a pap
smear at an Air Force medical facility between June
and September 1977 and have not been subsequently
reexamined should contact the facility immediately to
determine whether a reexamination is necessary.
The Air Force recently discovered that some pap
smears taken at 94 Air Force facilities throughout the
world may have been misclassified by an Air Force
Since 1 July 1972, the Air Force has used the services
of this contractor periodically. As an extra precaution,
women who had pap smears at an Air Force facility
between 1 July 1972 and May 1977 — and have not had
one other than at an Air Force installation since then —
should consult a doctor to determine if a reexamination
CORRECTION ... The Navy Editor Service recently
listed the Navy Physician's Assistant Program, Navy
Enlisted Nursing Education Program, and Navy En-
listed Dietetic Education Program as "paths to a com-
mission. ' ' This information was erroneous and will be
corrected by NES; nonetheless, it may crop up in
current Navy publications.
The programs referred to are no longer in existence.
The Physician's Assistant Program is being revised and
will be reinstituted in the coming year. Eligibility and
application procedures are being finalized at this time.
AUDIT TIPS . . . The following discrepancies were
noted on a recently completed audit:
• Establish separate bulk storage areas for Navy stan-
dard stock and commercial distributor provisions items.
• Revise current procedures for custody and handling
of keys to comply with the guidelines established by
NAVSUP P-486, para. 1056.
• Ensure that shelf-life items are identified, controlled,
and inspected in accordance with NAVSUP Manual
para. 21108-24031 and NAVMEDMATSUPPCOM-
FMSO Instruction 4000.1.
Volume 69, Septemt-ar 1978
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